- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $3,600.00 / $12,154.00
| Facility | | $1,500.00 | $3,600.00 | $12,154.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.90 / $233.02 / $316.62
| Professional | | $210.90 | $233.02 | $316.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $624.00 / $624.00
| Facility | | $624.00 | $624.00 | $624.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.69 / $337.69 / $337.69
| Professional | | $337.69 | $337.69 | $337.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.05 / $285.85 / $9,507.00
| Facility | | $212.05 | $285.85 | $9,507.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.95 / $341.53 / $1,840.00
| Professional | | $275.95 | $341.53 | $1,840.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,407.00 / $12,989.00
| Facility | | $2,269.00 | $6,407.00 | $12,989.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.18 / $327.30 / $441.42
| Professional | | $278.18 | $327.30 | $441.42 |