- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,548.13 / $10,000.00
| Facility | | $1,096.48 | $3,548.13 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,344.23 / $6,456.54
| Professional | | $1,122.02 | $2,344.23 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,467.37 / $7,079.46
| Facility | | $1,445.44 | $3,467.37 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $47.86
| Professional | | $0.02 | $0.02 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $20,892.96
| Facility | | $34.67 | $34.67 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $1,230.27 / $4,570.88
| Professional | | $97.72 | $1,230.27 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,071.52 / $3,467.37
| Facility | | $213.80 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $53.70 / $72.44
| Professional | | $39.81 | $53.70 | $72.44 |