- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $3,019.95 / $10,964.78
| Facility | | $457.09 | $3,019.95 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $1,096.48 / $5,495.41
| Professional | | $251.19 | $1,096.48 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $302.00
| Professional | | $281.84 | $281.84 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,623.41 / $8,912.51
| Facility | | $5,011.87 | $5,623.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $537.03 / $3,715.35
| Professional | | $218.78 | $537.03 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $758.58 / $5,248.07
| Professional | | $288.40 | $758.58 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $2,187.76 / $5,011.87
| Professional | | $263.03 | $2,187.76 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $2,187.76 / $4,786.30
| Professional | | $338.84 | $2,187.76 | $4,786.30 |