- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $3,235.94 / $8,511.38
| Facility | | $288.40 | $3,235.94 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $354.81 / $933.25
| Professional | | $141.25 | $354.81 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Professional | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,128.61 / $10,000.00
| Facility | | $3,890.45 | $5,128.61 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $309.03 / $724.44
| Professional | | $158.49 | $309.03 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $416.87 / $1,047.13
| Professional | | $158.49 | $416.87 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $660.69 / $5,128.61
| Facility | | $162.18 | $660.69 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $776.25 / $3,467.37
| Professional | | $489.78 | $776.25 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $776.25 / $1,096.48
| Professional | | $331.13 | $776.25 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $776.25
| Professional | | $309.03 | $309.03 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $416.87 / $1,047.13
| Professional | | $3.02 | $416.87 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,365.16 / $8,128.31
| Facility | | $2,570.40 | $4,365.16 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $457.09 / $912.01
| Professional | | $190.55 | $457.09 | $912.01 |