- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $3,801.89 / $8,511.38
| Facility | | $309.03 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $158.49 / $407.38
| Professional | | $58.88 | $158.49 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,365.16 / $8,511.38
| Facility | | $3,388.44 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $131.83 / $295.12
| Professional | | $67.61 | $131.83 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $323.59 / $467.74
| Professional | | $131.83 | $323.59 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.44 / $223.87 / $2,187.76
| Facility | | $72.44 | $223.87 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $1,318.26
| Professional | | $281.84 | $446.68 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $346.74 / $630.96
| Professional | | $131.83 | $346.74 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $181.97 / $467.74
| Professional | | $131.83 | $181.97 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,162.28 / $8,128.31
| Facility | | $1,905.46 | $3,162.28 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $323.59 / $602.56
| Professional | | $154.88 | $323.59 | $602.56 |