- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,630.78 / $8,912.51
| Facility | | $446.68 | $3,630.78 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $295.12 / $575.44
| Professional | | $239.88 | $295.12 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $323.59 / $467.74
| Professional | | $245.47 | $323.59 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $416.87 / $6,918.31
| Professional | | $269.15 | $416.87 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $363.08 / $831.76
| Professional | | $263.03 | $363.08 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $269.15 / $660.69
| Professional | | $218.78 | $269.15 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,659.59 / $2,089.30
| Professional | | $389.05 | $1,659.59 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $398.11 / $1,905.46
| Facility | | $263.03 | $398.11 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $10,000.00
| Facility | | $245.47 | $354.81 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $436.52 / $10,000.00
| Professional | | $263.03 | $436.52 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $11,481.54 / $23,988.33
| Facility | | $6,760.83 | $11,481.54 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $389.05 / $1,819.70
| Professional | | $229.09 | $389.05 | $1,819.70 |