- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $2,398.83 / $8,912.51
| Facility | | $223.87 | $2,398.83 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $114.82 / $177.83
| Professional | | $56.23 | $114.82 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,737.80 / $3,019.95
| Facility | | $1,584.89 | $1,737.80 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $128.82 / $251.19
| Professional | | $54.95 | $128.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $169.82 / $346.74
| Professional | | $85.11 | $169.82 | $346.74 |
- 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
- $67.61 / $151.36 / $323.59
| Professional | | $67.61 | $151.36 | $323.59 |
- 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
- $83.18 / $169.82 / $323.59
| Professional | | $83.18 | $169.82 | $323.59 |