- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $4,897.79 / $16,595.87
| Facility | | $257.04 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $218.78 / $371.54
| Professional | | $141.25 | $218.78 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,778.28 / $3,162.28
| Facility | | $794.33 | $1,778.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $165.96 / $275.42
| Professional | | $79.43 | $165.96 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $831.76 / $1,071.52
| Facility | | $371.54 | $831.76 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $239.88 / $416.87
| Professional | | $144.54 | $239.88 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $245.47 / $478.63
| Facility | | $131.83 | $245.47 | $478.63 |
- 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
- $131.83 / $204.17 / $371.54
| Professional | | $131.83 | $204.17 | $371.54 |