- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,073.80 / $10,000.00
| Facility | | $1,380.38 | $4,073.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $11,481.54
| Professional | | $1,000.00 | $3,311.31 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $7,585.78 / $15,848.93
| Facility | | $3,388.44 | $7,585.78 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $446.68 / $912.01
| Professional | | $363.08 | $446.68 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $11,220.18 / $53,703.18
| Facility | | $323.59 | $11,220.18 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $831.76
| Professional | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,495.41 / $12,589.25
| Facility | | $1,659.59 | $5,495.41 | $12,589.25 |