- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,388.44 / $14,791.08
| Facility | | $2,041.74 | $3,388.44 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $588.84 / $1,584.89
| Professional | | $416.87 | $588.84 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,000.00 / $18,197.01
| Facility | | $8,912.51 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,023.29 / $1,479.11
| Professional | | $457.09 | $1,023.29 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,023.29 / $1,621.81
| Professional | | $467.74 | $1,023.29 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $851.14 / $1,445.44
| Professional | | $524.81 | $851.14 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $933.25 / $1,862.09
| Professional | | $602.56 | $933.25 | $1,862.09 |