- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $4,897.79 / $10,471.29
| Facility | | $354.81 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $199.53 / $537.03
| Professional | | $169.82 | $199.53 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,168.69 / $12,022.64
| Facility | | $3,715.35 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $380.19 / $562.34
| Professional | | $234.42 | $380.19 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $354.81 / $537.03
| Professional | | $223.87 | $354.81 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $275.42 / $371.54
| Professional | | $177.83 | $275.42 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,754.40 / $10,000.00
| Facility | | $1,513.56 | $5,754.40 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $281.84 / $562.34
| Professional | | $169.82 | $281.84 | $562.34 |