- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $257.04 / $10,000.00
| Facility | | $112.20 | $257.04 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $141.25 / $645.65
| Professional | | $134.90 | $141.25 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $64,565.42 / $64,565.42
| Professional | | $54,954.09 | $64,565.42 | $64,565.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.88 / $346.74 / $416.87
| Facility | | $58.88 | $346.74 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $380.19 / $25,118.86
| Facility | | $123.03 | $380.19 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $257.04 / $10,000.00
| Facility | | $112.20 | $257.04 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $141.25 / $645.65
| Professional | | $134.90 | $141.25 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $512.86 / $3,890.45
| Facility | | $162.18 | $512.86 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $60.26 / $125.89
| Professional | | $34.67 | $60.26 | $125.89 |