- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,548.82 / $6,309.57
| Facility | | $288.40 | $1,548.82 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $269.15 / $478.63
| Professional | | $199.53 | $269.15 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,709.64 / $12,022.64
| Facility | | $6,918.31 | $8,709.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $257.04 / $354.81
| Professional | | $190.55 | $257.04 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $1,737.80 / $2,691.53
| Professional | | $204.17 | $1,737.80 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $295.12 / $436.52
| Professional | | $204.17 | $295.12 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $263.03 / $323.59
| Professional | | $165.96 | $263.03 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $446.68 / $524.81
| Professional | | $354.81 | $446.68 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $323.59 / $489.78
| Facility | | $213.80 | $323.59 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $263.03 / $10,000.00
| Facility | | $173.78 | $263.03 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $354.81 / $10,000.00
| Professional | | $204.17 | $354.81 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,073.80 / $14,791.08
| Facility | | $1,737.80 | $4,073.80 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $302.00 / $467.74
| Professional | | $181.97 | $302.00 | $467.74 |