- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.00 / $3,188.00 / $10,836.00
| Facility | | $727.00 | $3,188.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.12 / $256.08 / $371.54
| Professional | | $222.12 | $256.08 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,096.38 / $3,922.02 / $7,537.78
| Facility | | $2,096.38 | $3,922.02 | $7,537.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.73 / $278.33 / $405.08
| Professional | | $207.73 | $278.33 | $405.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.88 / $220.88 / $220.88
| Facility | | $220.88 | $220.88 | $220.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,403.30 / $2,403.30 / $2,403.30
| Facility | | $2,403.30 | $2,403.30 | $2,403.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.73 / $348.92 / $535.29
| Professional | | $254.73 | $348.92 | $535.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $9,496.40
| Facility | | $55.00 | $55.00 | $9,496.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,806.88 / $2,806.88 / $2,806.88
| Professional | | $2,806.88 | $2,806.88 | $2,806.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.63 / $331.79 / $674.46
| Facility | | $245.63 | $331.79 | $674.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.42 / $377.11 / $443.66
| Professional | | $320.42 | $377.11 | $443.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.70 / $371.70 / $371.70
| Professional | | $371.70 | $371.70 | $371.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.63 / $332.98 / $674.46
| Facility | | $245.63 | $332.98 | $674.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.73 / $359.88 / $558.86
| Professional | | $254.73 | $359.88 | $558.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,314.00 / $7,600.00
| Facility | | $1,154.00 | $3,314.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.24 / $283.27 / $444.19
| Professional | | $207.24 | $283.27 | $444.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.36 / $239.70 / $332.07
| Professional | | $210.36 | $239.70 | $332.07 |