- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.00 / $5,982.24 / $10,965.00
| Facility | | $1,819.00 | $5,982.24 | $10,965.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.00 / $2,626.00 / $10,686.00
| Professional | | $645.00 | $2,626.00 | $10,686.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Professional | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,350.00 / $4,050.00
| Facility | | $1,350.00 | $1,350.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,538.00 / $7,227.90 / $7,227.90
| Facility | | $1,538.00 | $7,227.90 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.00 / $385.00 / $385.00
| Professional | | $385.00 | $385.00 | $385.00 |
- 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
- $7,738.34 / $7,738.34 / $7,738.34
| Facility | | $7,738.34 | $7,738.34 | $7,738.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,011.50 / $1,011.50 / $1,011.50
| Professional | | $1,011.50 | $1,011.50 | $1,011.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $7,227.90 / $74,999.25
| Facility | | $555.00 | $7,227.90 | $74,999.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.00 / $385.00 / $385.00
| Professional | | $385.00 | $385.00 | $385.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $951.00 / $3,235.00 / $5,828.00
| Facility | | $951.00 | $3,235.00 | $5,828.00 |