- 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
- $109.65 / $588.84 / $6,165.95
| Professional | | $109.65 | $588.84 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,265.80 / $15,135.61
| Facility | | $1,174.90 | $4,265.80 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $97.72
| Professional | | $0.02 | $0.02 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $323.59 / $10,000.00
| Facility | | $34.67 | $323.59 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $457.09 / $7,244.36
| Professional | | $97.72 | $457.09 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,071.52 / $3,467.37
| Facility | | $213.80 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $57.54 / $61.66
| Professional | | $39.81 | $57.54 | $61.66 |