- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $6,309.57 / $6,309.57
| Facility | | $120.23 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $173.78 / $389.05
| Professional | | $117.49 | $173.78 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $165.96
| Facility | | $138.04 | $138.04 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $147.91
| Professional | | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $1,659.59
| Facility | | $223.87 | $223.87 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $186.21 / $933.25
| Professional | | $125.89 | $186.21 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $10,000.00
| Facility | | $2,951.21 | $2,951.21 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $5,754.40
| Facility | | $1,230.27 | $1,230.27 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $138.04 / $223.87
| Professional | | $97.72 | $138.04 | $223.87 |