- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $4,570.88 / $10,000.00
| Facility | | $562.34 | $4,570.88 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $316.23 / $977.24
| Professional | | $204.17 | $316.23 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,456.54 / $12,589.25
| Facility | | $2,454.71 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $245.47 / $457.09
| Professional | | $173.78 | $245.47 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $758.58 / $2,290.87
| Facility | | $363.08 | $758.58 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $295.12 / $630.96
| Professional | | $199.53 | $295.12 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,981.07 / $9,549.93
| Facility | | $1,023.29 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $239.88 / $436.52
| Professional | | $169.82 | $239.88 | $436.52 |