- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,890.45 / $10,000.00
| Facility | | $1,071.52 | $3,890.45 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $616.60 / $977.24
| Professional | | $251.19 | $616.60 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,897.79 / $13,489.63
| Facility | | $2,137.96 | $4,897.79 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $162.18 / $977.24
| Professional | | $41.69 | $162.18 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,089.30 / $5,754.40
| Facility | | $302.00 | $2,089.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $851.14 / $2,344.23
| Professional | | $208.93 | $851.14 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $10,232.93
| Facility | | $1,513.56 | $4,265.80 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $812.83 / $1,412.54
| Professional | | $501.19 | $812.83 | $1,412.54 |