- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,585.78 / $10,471.29
| Facility | | $4,570.88 | $7,585.78 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $4,570.88 / $8,912.51
| Professional | | $676.08 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,162.28 / $10,232.93
| Facility | | $1,621.81 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.02
| Professional | | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $54,954.09
| Professional | | $54,954.09 | $54,954.09 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $4,168.69 / $7,762.47
| Facility | | $630.96 | $4,168.69 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Professional | | $50.12 | $50.12 | $50.12 |