- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,754.23 / $11,481.54
| Facility | | $1,071.52 | $2,754.23 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $831.76 / $1,584.89
| Professional | | $295.12 | $831.76 | $1,584.89 |
- 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 / $3,019.95
| Professional | | $295.12 | $912.01 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $2,454.71 / $3,715.35
| Professional | | $575.44 | $2,454.71 | $3,715.35 |
- 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 / $1,659.59 / $3,981.07
| Professional | | $354.81 | $1,659.59 | $3,981.07 |
- 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
- $398.11 / $1,513.56 / $3,890.45
| Professional | | $398.11 | $1,513.56 | $3,890.45 |