- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,311.31 / $10,000.00
| Facility | | $407.38 | $3,311.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $204.17 / $407.38
| Professional | | $131.83 | $204.17 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $269.15 / $371.54
| Professional | | $208.93 | $269.15 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $354.81
| Facility | | $323.59 | $323.59 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Professional | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $229.09 / $257.04
| Professional | | $117.49 | $229.09 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $446.68
| Professional | | $32.36 | $33.11 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,778.28 / $4,168.69
| Facility | | $346.74 | $1,778.28 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $239.88 / $512.86
| Professional | | $128.82 | $239.88 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $257.04
| Professional | | $190.55 | $190.55 | $257.04 |