- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,398.83 / $11,481.54
| Facility | | $2,290.87 | $2,398.83 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $588.84 / $1,778.28
| Professional | | $524.81 | $588.84 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,677.35 / $6,309.57
| Facility | | $3,467.37 | $4,677.35 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,202.26 / $1,737.80
| Professional | | $524.81 | $1,202.26 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $1,096.48 / $1,949.84
| Professional | | $234.42 | $1,096.48 | $1,949.84 |
- 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
- $588.84 / $954.99 / $1,621.81
| Professional | | $588.84 | $954.99 | $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
- $676.08 / $954.99 / $1,949.84
| Professional | | $676.08 | $954.99 | $1,949.84 |