- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,778.28 / $8,709.64
| Facility | | $1,096.48 | $1,778.28 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $35,481.34
| Facility | | $489.78 | $575.44 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Professional | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,348.96 / $2,137.96
| Facility | | $1,047.13 | $1,348.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $8,709.64 / $19,952.62
| Facility | | $1,737.80 | $8,709.64 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $10,000.00 / $10,000.00
| Facility | | $56.23 | $10,000.00 | $10,000.00 |