- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $4,897.79 / $9,772.37
| Facility | | $389.05 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $446.68 / $1,548.82
| Professional | | $131.83 | $446.68 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $1,348.96 / $1,380.38
| Professional | | $114.82 | $1,348.96 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,023.29 / $2,041.74
| Facility | | $549.54 | $1,023.29 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $177.83 / $1,071.52
| Professional | | $120.23 | $177.83 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $537.03 / $616.60
| Facility | | $229.09 | $537.03 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $478.63 / $1,737.80
| Professional | | $158.49 | $478.63 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,513.56
| Professional | | $1,445.44 | $1,445.44 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $707.95 / $1,621.81
| Facility | | $147.91 | $707.95 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Professional | | $1,479.11 | $1,479.11 | $1,479.11 |
- 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
- $128.82 / $537.03 / $1,479.11
| Professional | | $128.82 | $537.03 | $1,479.11 |