- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,388.44 / $10,000.00
| Facility | | $933.25 | $3,388.44 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $281.84 / $407.38
| Professional | | $199.53 | $281.84 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,570.88 / $12,022.64
| Facility | | $2,570.40 | $4,570.88 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $229.09 / $389.05
| Professional | | $162.18 | $229.09 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $645.65 / $2,454.71
| Facility | | $323.59 | $645.65 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $380.19 / $1,174.90
| Professional | | $309.03 | $380.19 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $1,047.13 / $3,467.37
| Facility | | $158.49 | $1,047.13 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $588.84
| Professional | | $234.42 | $338.84 | $588.84 |