- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.27 / $1,615.00 / $7,439.00
| Facility | | $258.27 | $1,615.00 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.27 / $258.27 / $303.14
| Professional | | $258.27 | $258.27 | $303.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.66 / $658.66 / $941.14
| Facility | | $658.66 | $658.66 | $941.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.91 / $552.80 / $708.28
| Professional | | $388.91 | $552.80 | $708.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,221.62 / $10,221.62 / $10,221.62
| Facility | | $10,221.62 | $10,221.62 | $10,221.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,577.98 / $1,577.98 / $1,577.98
| Professional | | $1,577.98 | $1,577.98 | $1,577.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.27 / $266.08 / $335.76
| Facility | | $258.27 | $266.08 | $335.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.08 / $266.08 / $494.00
| Professional | | $266.08 | $266.08 | $494.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.20 / $540.20 / $540.20
| Professional | | $540.20 | $540.20 | $540.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $554.00 / $2,417.00 / $4,102.00
| Facility | | $554.00 | $2,417.00 | $4,102.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.08 / $350.89 / $638.59
| Professional | | $226.08 | $350.89 | $638.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.31 / $29,484.87 / $33,780.60
| Facility | | $322.31 | $29,484.87 | $33,780.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,103.65 / $2,888.10 / $2,888.10
| Professional | | $2,103.65 | $2,888.10 | $2,888.10 |