- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.99 / $630.02 / $7,439.00
| Facility | | $255.99 | $630.02 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.80 / $255.99 / $303.87
| Professional | | $192.80 | $255.99 | $303.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.27 / $100.00 / $765.03
| Professional | | $20.27 | $100.00 | $765.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,316.93 / $4,316.93 / $4,316.93
| Facility | | $4,316.93 | $4,316.93 | $4,316.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,386.60 / $1,386.60 / $1,386.60
| Professional | | $1,386.60 | $1,386.60 | $1,386.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.59 / $275.58 / $307.19
| Facility | | $217.59 | $275.58 | $307.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.58 / $275.58 / $287.00
| Professional | | $275.58 | $275.58 | $287.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.20 / $400.20 / $400.20
| Professional | | $400.20 | $400.20 | $400.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.25 / $241.25 / $536.96
| Professional | | $25.25 | $241.25 | $536.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.02 / $12,452.47 / $14,266.70
| Facility | | $727.02 | $12,452.47 | $14,266.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,200.80 / $2,635.65 / $2,635.65
| Professional | | $2,200.80 | $2,635.65 | $2,635.65 |