- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $4,168.69 / $5,370.32
| Facility | | $91.20 | $4,168.69 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $141.25 / $263.03
| Professional | | $95.50 | $141.25 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,786.30 / $10,232.93
| Facility | | $2,137.96 | $4,786.30 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $288.40 / $512.86
| Professional | | $186.21 | $288.40 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $562.34 / $1,348.96
| Facility | | $398.11 | $562.34 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $407.38 / $645.65
| Professional | | $223.87 | $407.38 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $537.03 / $1,071.52
| Facility | | $436.52 | $537.03 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $338.84 / $602.56
| Professional | | $223.87 | $338.84 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $288.40 / $5,011.87
| Facility | | $141.25 | $288.40 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $316.23 / $758.58
| Professional | | $177.83 | $316.23 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,467.37 / $6,456.54
| Facility | | $1,000.00 | $3,467.37 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $257.04 / $501.19
| Professional | | $144.54 | $257.04 | $501.19 |