- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,038.08 / $2,038.08 / $2,038.08
| Facility | | $2,038.08 | $2,038.08 | $2,038.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.00 / $199.75 / $448.87
| Professional | | $123.00 | $199.75 | $448.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,000.00 / $81,499.99 / $94,999.99
| Facility | | $47,000.00 | $81,499.99 | $94,999.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.48 / $203.48 / $431.68
| Professional | | $203.48 | $203.48 | $431.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.48 / $203.48 / $203.48
| Facility | | $203.48 | $203.48 | $203.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.48 / $246.19 / $548.83
| Professional | | $203.48 | $246.19 | $548.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.34 / $581.10 / $624.91
| Facility | | $125.34 | $581.10 | $624.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.63 / $270.89 / $514.36
| Professional | | $135.63 | $270.89 | $514.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.33 / $485.50 / $756.66
| Professional | | $398.33 | $485.50 | $756.66 |