- 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
- $9,332.54 / $11,481.54 / $17,782.79
| Professional | | $9,332.54 | $11,481.54 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $13,803.84 / $13,803.84
| Facility | | $13,803.84 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $22,387.21
| Professional | | $10,000.00 | $10,000.00 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $14,125.38 / $72,443.60
| Facility | | $10,000.00 | $14,125.38 | $72,443.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $10,964.78 / $30,199.52
| Professional | | $6,309.57 | $10,964.78 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $22,387.21 / $22,387.21
| Facility | | $12,589.25 | $22,387.21 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $10,471.29 / $14,454.40
| Professional | | $6,309.57 | $10,471.29 | $14,454.40 |