- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,754.23 / $11,481.54
| Facility | | $1,174.90 | $2,754.23 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $954.99 / $2,511.89
| Professional | | $331.13 | $954.99 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Professional | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $5,495.41 / $8,128.31
| Facility | | $4,897.79 | $5,495.41 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $912.01 / $2,754.23
| Professional | | $295.12 | $912.01 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $2,238.72 / $4,073.80
| Professional | | $645.65 | $2,238.72 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,479.11 / $3,548.13
| Professional | | $354.81 | $1,479.11 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,737.80 / $4,466.84
| Professional | | $436.52 | $1,737.80 | $4,466.84 |