- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.00 / $3,643.00 / $10,649.00
| Facility | | $923.00 | $3,643.00 | $10,649.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.15 / $251.20 / $4,573.00
| Professional | | $84.15 | $251.20 | $4,573.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,001.15 / $7,202.23 / $14,646.14
| Facility | | $4,001.15 | $7,202.23 | $14,646.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,063.00 / $6,063.00 / $6,063.00
| Facility | | $6,063.00 | $6,063.00 | $6,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,277.00 / $4,619.00
| Facility | | $900.00 | $2,277.00 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,428.72 / $1,428.72 / $1,428.72
| Professional | | $1,428.72 | $1,428.72 | $1,428.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $10,160.00 / $10,160.00
| Facility | | $55.00 | $10,160.00 | $10,160.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,335.23 / $3,335.23 / $3,335.23
| Professional | | $3,335.23 | $3,335.23 | $3,335.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,478.00 / $5,478.00 / $9,074.00
| Professional | | $5,478.00 | $5,478.00 | $9,074.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,277.00 / $2,530.00
| Facility | | $900.00 | $2,277.00 | $2,530.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,428.72 / $1,428.72 / $1,428.72
| Professional | | $1,428.72 | $1,428.72 | $1,428.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $5,870.00 / $13,237.00
| Facility | | $2,093.00 | $5,870.00 | $13,237.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.18 / $750.00 / $750.00
| Professional | | $430.18 | $750.00 | $750.00 |