- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,467.37 / $9,772.37
| Facility | | $1,000.00 | $3,467.37 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,380.38 / $4,365.16
| Professional | | $562.34 | $1,380.38 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,168.69 / $15,135.61
| Facility | | $1,122.02 | $4,168.69 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $46.77 / $891.25
| Professional | | $0.02 | $46.77 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $1,000.00
| Facility | | $34.67 | $398.11 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,096.48 / $10,000.00
| Professional | | $316.23 | $1,096.48 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,467.37
| Facility | | $204.17 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $63.10 / $316.23
| Professional | | $39.81 | $63.10 | $316.23 |