- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $5,011.87 / $10,000.00
| Facility | | $676.08 | $5,011.87 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $501.19 / $1,905.46
| Professional | | $398.11 | $501.19 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $616.60 / $870.96
| Professional | | $446.68 | $616.60 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $3,890.45 / $5,623.41
| Professional | | $489.78 | $3,890.45 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $812.83
| Facility | | $34.67 | $34.67 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $588.84 / $954.99
| Professional | | $457.09 | $588.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $537.03 / $630.96
| Professional | | $436.52 | $537.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $524.81 / $758.58
| Facility | | $416.87 | $524.81 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Professional | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $676.08 / $10,000.00
| Facility | | $457.09 | $676.08 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $676.08 / $10,000.00
| Professional | | $457.09 | $676.08 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,549.93 / $19,054.61
| Facility | | $5,623.41 | $9,549.93 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $562.34 / $933.25
| Professional | | $398.11 | $562.34 | $933.25 |