- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $3,235.94 / $10,000.00
| Facility | | $512.86 | $3,235.94 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $1,479.11
| Professional | | $446.68 | $645.65 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,456.54 / $10,964.78
| Facility | | $3,467.37 | $6,456.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $724.44 / $1,148.15
| Professional | | $562.34 | $724.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $4,168.69
| Facility | | $851.14 | $851.14 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $660.69 / $1,096.48
| Professional | | $501.19 | $660.69 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $676.08 / $1,862.09
| Professional | | $478.63 | $676.08 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $812.83
| Professional | | $478.63 | $478.63 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,025.60 / $11,481.54
| Facility | | $2,630.27 | $6,025.60 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $660.69 / $1,288.25
| Professional | | $489.78 | $660.69 | $1,288.25 |