- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $4,897.79 / $10,471.29
| Facility | | $208.93 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $117.49 / $229.09
| Professional | | $100.00 | $117.49 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $12,302.69 / $13,803.84
| Facility | | $6,760.83 | $12,302.69 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $213.80 / $295.12
| Professional | | $104.71 | $213.80 | $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
- $117.49 / $173.78 / $354.81
| Professional | | $117.49 | $173.78 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $169.82 / $204.17
| Professional | | $128.82 | $169.82 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $4,786.30 / $10,000.00
| Facility | | $758.58 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $147.91 / $323.59
| Professional | | $100.00 | $147.91 | $323.59 |