- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,516.00 / $5,845.00 / $10,686.00
| Facility | | $1,516.00 | $5,845.00 | $10,686.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.27 / $89.63 / $101.33
| Professional | | $56.27 | $89.63 | $101.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,040.00 / $10,294.00 / $19,351.80
| Facility | | $5,040.00 | $10,294.00 | $19,351.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.16 / $643.33 / $1,072.23
| Professional | | $537.16 | $643.33 | $1,072.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,227.90 / $21,417.00 / $59,610.00
| Facility | | $7,227.90 | $21,417.00 | $59,610.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,261.04 / $9,261.04 / $9,261.04
| Professional | | $9,261.04 | $9,261.04 | $9,261.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.29 / $1,431.61 / $2,943.16
| Professional | | $648.29 | $1,431.61 | $2,943.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,209.59 / $18,211.00 / $32,297.00
| Facility | | $2,209.59 | $18,211.00 | $32,297.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,261.04 / $9,261.04 / $9,261.04
| Professional | | $9,261.04 | $9,261.04 | $9,261.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.00 / $4,194.00 / $9,300.00
| Facility | | $1,749.00 | $4,194.00 | $9,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.49 / $101.35 / $246.50
| Professional | | $61.49 | $101.35 | $246.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.42 / $682.42 / $682.42
| Facility | | $682.42 | $682.42 | $682.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.50 / $682.42 / $2,864.06
| Professional | | $173.50 | $682.42 | $2,864.06 |