- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,467.37 / $10,000.00
| Facility | | $1,000.00 | $3,467.37 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,412.54 / $6,606.93
| Professional | | $354.81 | $1,412.54 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $6,025.60 / $16,218.10
| Facility | | $1,548.82 | $6,025.60 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $4,570.88
| Professional | | $0.02 | $0.03 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $4,570.88
| Facility | | $34.67 | $398.11 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,698.24 / $5,754.40
| Professional | | $776.25 | $1,698.24 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,630.78
| Facility | | $204.17 | $1,071.52 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $158.49 / $338.84
| Professional | | $39.81 | $158.49 | $338.84 |