- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $4,200.00 / $9,868.00
| Facility | | $1,550.00 | $4,200.00 | $9,868.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.70 / $1,374.40 / $2,626.00
| Professional | | $196.70 | $1,374.40 | $2,626.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.18 / $53.58 / $53.58
| Professional | | $40.18 | $53.58 | $53.58 |
- 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
- $780.00 / $780.00 / $780.00
| Professional | | $780.00 | $780.00 | $780.00 |
- 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
- $2,890.98 / $2,890.98 / $2,890.98
| Facility | | $2,890.98 | $2,890.98 | $2,890.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.55 / $325.55 / $325.55
| Professional | | $325.55 | $325.55 | $325.55 |
- 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
- $780.00 / $780.00 / $780.00
| Professional | | $780.00 | $780.00 | $780.00 |
- 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 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $202.00
| Professional | | $64.00 | $64.00 | $202.00 |