- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $8,709.64 / $16,595.87
| Facility | | $933.25 | $8,709.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $389.05 / $602.56
| Professional | | $288.40 | $389.05 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,897.79 / $9,120.11
| Facility | | $2,290.87 | $4,897.79 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $407.38 / $616.60
| Professional | | $309.03 | $407.38 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $1,621.81
| Facility | | $575.44 | $575.44 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $457.09 / $616.60
| Professional | | $331.13 | $457.09 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $630.96
| Professional | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $446.68 / $676.08
| Facility | | $331.13 | $446.68 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $6,760.83 / $10,000.00
| Facility | | $1,698.24 | $6,760.83 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $389.05 / $724.44
| Professional | | $288.40 | $389.05 | $724.44 |