- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,162.28 / $8,317.64
| Facility | | $323.59 | $3,162.28 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $234.42 / $741.31
| Professional | | $151.36 | $234.42 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $169.82 / $173.78
| Professional | | $169.82 | $169.82 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,165.95 / $57,543.99
| Facility | | $5,011.87 | $6,165.95 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $251.19 / $398.11
| Professional | | $173.78 | $251.19 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $446.68 / $501.19
| Professional | | $354.81 | $446.68 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $323.59 / $512.86
| Professional | | $199.53 | $323.59 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,754.40 / $10,000.00
| Facility | | $4,265.80 | $5,754.40 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $2,691.53 / $8,317.64
| Facility | | $389.05 | $2,691.53 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $263.03 / $630.96
| Professional | | $158.49 | $263.03 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $169.82 / $169.82
| Professional | | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $204.17 / $407.38
| Facility | | $165.96 | $204.17 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $251.19 / $407.38
| Professional | | $165.96 | $251.19 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,548.13 / $8,912.51
| Facility | | $1,348.96 | $3,548.13 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $229.09 / $398.11
| Professional | | $151.36 | $229.09 | $398.11 |