- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $4,897.79 / $16,595.87
| Facility | | $223.87 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $173.78 / $269.15
| Professional | | $79.43 | $173.78 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $870.96 / $2,290.87
| Facility | | $524.81 | $870.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $190.55 / $251.19
| Professional | | $69.18 | $190.55 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $165.96 / $575.44
| Facility | | $138.04 | $165.96 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $208.93 / $426.58
| Professional | | $95.50 | $208.93 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $186.21 / $354.81
| Facility | | $83.18 | $186.21 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $162.18
| Professional | | $162.18 | $162.18 | $162.18 |
- 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
- $616.60 / $6,165.95 / $10,000.00
| Facility | | $616.60 | $6,165.95 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $162.18 / $316.23
| Professional | | $75.86 | $162.18 | $316.23 |