- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,890.45 / $10,000.00
| Facility | | $1,023.29 | $3,890.45 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $323.59 / $512.86
| Professional | | $281.84 | $323.59 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,495.41 / $12,022.64
| Facility | | $2,290.87 | $5,495.41 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $407.38 / $691.83
| Professional | | $275.42 | $407.38 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $724.44 / $1,862.09
| Facility | | $501.19 | $724.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $407.38 / $851.14
| Professional | | $281.84 | $407.38 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,570.40 / $6,165.95
| Facility | | $660.69 | $2,570.40 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $346.74 / $630.96
| Professional | | $251.19 | $346.74 | $630.96 |