- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.54 / $367.54 / $7,968.00
| Facility | | $367.54 | $367.54 | $7,968.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.04 / $367.54 / $415.49
| Professional | | $300.04 | $367.54 | $415.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,753.89 / $4,753.89 / $4,823.27
| Facility | | $4,753.89 | $4,753.89 | $4,823.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.16 / $902.86 / $1,179.98
| Professional | | $611.16 | $902.86 | $1,179.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.59 / $6,025.59 / $6,025.59
| Facility | | $6,025.59 | $6,025.59 | $6,025.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.56 / $325.56 / $325.56
| Professional | | $325.56 | $325.56 | $325.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.54 / $390.34 / $512.54
| Facility | | $367.54 | $390.34 | $512.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.34 / $390.34 / $468.00
| Professional | | $390.34 | $390.34 | $468.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.60 / $463.60 / $463.60
| Professional | | $463.60 | $463.60 | $463.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.07 / $440.29 / $828.67
| Professional | | $330.07 | $440.29 | $828.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $668.85 / $17,381.18 / $19,913.50
| Facility | | $668.85 | $17,381.18 | $19,913.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,316.04 / $3,006.90 / $3,006.90
| Professional | | $2,316.04 | $3,006.90 | $3,006.90 |