- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,754.23 / $11,481.54
| Facility | | $2,398.83 | $2,754.23 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $204.17 / $275.42
| Professional | | $158.49 | $204.17 | $275.42 |
- 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
- $169.82 / $346.74 / $501.19
| Professional | | $169.82 | $346.74 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $398.11 / $549.54
| Professional | | $229.09 | $398.11 | $549.54 |
- 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
- $190.55 / $316.23 / $537.03
| Professional | | $190.55 | $316.23 | $537.03 |
- 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
- $218.78 / $363.08 / $660.69
| Professional | | $218.78 | $363.08 | $660.69 |