- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.32 / $1,259.75 / $3,371.53
| Facility | | $30.32 | $1,259.75 | $3,371.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $690.18 / $1,010.42
| Professional | | $150.00 | $690.18 | $1,010.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $25.50 / $30.00
| Professional | | $0.02 | $25.50 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.67 / $734.67 / $734.67
| Facility | | $734.67 | $734.67 | $734.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.52 / $240.52 / $240.52
| Professional | | $240.52 | $240.52 | $240.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.94 / $378.94 / $378.94
| Professional | | $378.94 | $378.94 | $378.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $734.67 / $74,999.25
| Facility | | $555.00 | $734.67 | $74,999.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.52 / $240.52 / $240.52
| Professional | | $240.52 | $240.52 | $240.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.68 / $437.68 / $683.77
| Professional | | $437.68 | $437.68 | $683.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.81 / $304.81 / $378.94
| Facility | | $304.81 | $304.81 | $378.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.81 / $378.94 / $378.94
| Professional | | $304.81 | $378.94 | $378.94 |