- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,981.07 / $10,000.00
| Facility | | $1,096.48 | $3,981.07 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $398.11 / $537.03
| Professional | | $295.12 | $398.11 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,606.93 / $13,803.84
| Facility | | $2,691.53 | $6,606.93 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $436.52 / $758.58
| Professional | | $263.03 | $436.52 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $977.24 / $18,197.01
| Facility | | $588.84 | $977.24 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,659.59 / $1,659.59
| Professional | | $549.54 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,456.54
| Facility | | $1,023.29 | $2,884.03 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $602.56 / $1,023.29
| Professional | | $398.11 | $602.56 | $1,023.29 |