- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $3,235.94 / $8,317.64
| Facility | | $363.08 | $3,235.94 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $331.13 / $398.11
| Professional | | $223.87 | $331.13 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $181.97 / $245.47
| Professional | | $125.89 | $181.97 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $457.09 / $467.74
| Professional | | $416.87 | $457.09 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Professional | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $371.54 / $478.63
| Professional | | $316.23 | $371.54 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $363.08 / $549.54
| Facility | | $257.04 | $363.08 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $676.08 / $10,000.00
| Facility | | $316.23 | $676.08 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $676.08 / $10,000.00
| Professional | | $316.23 | $676.08 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,202.26 / $2,454.71
| Facility | | $229.09 | $1,202.26 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $331.13 / $575.44
| Professional | | $245.47 | $331.13 | $575.44 |