- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,466.84 / $9,772.37
| Facility | | $1,148.15 | $4,466.84 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $5,248.07 / $21,379.62
| Professional | | $758.58 | $5,248.07 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $338.84 / $416.87
| Facility | | $302.00 | $338.84 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Professional | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $199.53 / $346.74
| Professional | | $100.00 | $199.53 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $2,511.89
| Professional | | $1,513.56 | $1,513.56 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $724.44 / $2,187.76
| Facility | | $158.49 | $724.44 | $2,187.76 |