- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $2,697.06 / $8,017.00
| Facility | | $657.00 | $2,697.06 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.04 / $323.37 / $416.02
| Professional | | $218.04 | $323.37 | $416.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.74 / $417.74 / $417.74
| Facility | | $417.74 | $417.74 | $417.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,646.42 / $1,646.42 / $1,646.42
| Professional | | $1,646.42 | $1,646.42 | $1,646.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.73 / $524.73 / $524.73
| Professional | | $524.73 | $524.73 | $524.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,921.44 / $24,092.03 / $26,989.99
| Facility | | $7,921.44 | $24,092.03 | $26,989.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.79 / $317.79 / $317.79
| Professional | | $317.79 | $317.79 | $317.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $2,675.00 / $8,017.00
| Facility | | $657.00 | $2,675.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.04 / $343.18 / $2,467.00
| Professional | | $218.04 | $343.18 | $2,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.74 / $417.74 / $417.74
| Facility | | $417.74 | $417.74 | $417.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,646.42 / $1,646.42 / $1,646.42
| Professional | | $1,646.42 | $1,646.42 | $1,646.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,368.00
| Facility | | $2,155.00 | $3,475.00 | $6,368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.31 / $457.33 / $738.85
| Professional | | $359.31 | $457.33 | $738.85 |