- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $10,000.00
| Facility | | $1,000.00 | $3,311.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,698.24 / $3,162.28
| Professional | | $776.25 | $1,698.24 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $10,000.00
| Facility | | $34.67 | $398.11 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,454.71 / $4,168.69
| Facility | | $1,548.82 | $2,454.71 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $50.12
| Professional | | $39.81 | $39.81 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,584.89 / $3,890.45
| Facility | | $245.47 | $1,584.89 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $39.81 / $60.26
| Professional | | $34.67 | $39.81 | $60.26 |