- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $3,467.37 / $7,244.36
| Facility | | $281.84 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $338.84 / $549.54
| Professional | | $165.96 | $338.84 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $354.81 / $602.56
| Professional | | $173.78 | $354.81 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $269.15 / $10,000.00
| Professional | | $177.83 | $269.15 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $354.81 / $707.95
| Professional | | $173.78 | $354.81 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $446.68 / $1,148.15
| Professional | | $144.54 | $446.68 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $794.33 / $954.99
| Professional | | $229.09 | $794.33 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $380.19 / $776.25
| Facility | | $181.97 | $380.19 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $223.87 / $2,951.21
| Facility | | $158.49 | $223.87 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $537.03 / $2,951.21
| Professional | | $354.81 | $537.03 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,137.96 / $3,981.07
| Facility | | $1,096.48 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $338.84 / $758.58
| Professional | | $147.91 | $338.84 | $758.58 |