- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,235.94 / $10,000.00
| Facility | | $630.96 | $3,235.94 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $354.81 / $691.83
| Professional | | $295.12 | $354.81 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,606.93 / $13,803.84
| Facility | | $2,511.89 | $6,606.93 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $363.08 / $707.95
| Professional | | $275.42 | $363.08 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $812.83 / $2,818.38
| Facility | | $346.74 | $812.83 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $436.52 / $933.25
| Professional | | $275.42 | $436.52 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,630.27 / $6,456.54
| Facility | | $645.65 | $2,630.27 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $371.54 / $676.08
| Professional | | $269.15 | $371.54 | $676.08 |