- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,575.60 / $4,043.00 / $10,170.00
| Facility | | $1,575.60 | $4,043.00 | $10,170.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.19 / $322.39 / $1,819.00
| Professional | | $161.19 | $322.39 | $1,819.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.18 / $1,096.83 / $1,218.70
| Professional | | $40.18 | $1,096.83 | $1,218.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,648.00 / $4,648.00 / $13,944.00
| Facility | | $4,648.00 | $4,648.00 | $13,944.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,538.00 / $7,227.90 / $39,142.00
| Facility | | $1,538.00 | $7,227.90 | $39,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.00 / $221.00 / $221.00
| Professional | | $221.00 | $221.00 | $221.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,813.00 / $8,640.00 / $8,640.00
| Facility | | $2,813.00 | $8,640.00 | $8,640.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,249.45 / $55,249.45 / $55,249.45
| Professional | | $55,249.45 | $55,249.45 | $55,249.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.26 / $1,123.26 / $1,123.26
| Facility | | $1,123.26 | $1,123.26 | $1,123.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.00 / $590.00 / $660.00
| Professional | | $590.00 | $590.00 | $660.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $7,227.90 / $39,142.00
| Facility | | $597.00 | $7,227.90 | $39,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.00 / $221.00 / $221.00
| Professional | | $221.00 | $221.00 | $221.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.00 / $3,612.00 / $8,133.00
| Facility | | $1,269.00 | $3,612.00 | $8,133.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $400.00
| Professional | | $64.00 | $64.00 | $400.00 |