- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,398.83 / $14,791.08
| Facility | | $2,187.76 | $2,398.83 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $549.54 / $1,698.24
| Professional | | $489.78 | $549.54 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,623.41 / $8,912.51
| Facility | | $5,011.87 | $5,623.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,122.02 / $1,621.81
| Professional | | $489.78 | $1,122.02 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $1,023.29 / $1,819.70
| Professional | | $234.42 | $1,023.29 | $1,819.70 |
- 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
- $549.54 / $891.25 / $1,513.56
| Professional | | $549.54 | $891.25 | $1,513.56 |
- 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
- $616.60 / $891.25 / $1,819.70
| Professional | | $616.60 | $891.25 | $1,819.70 |