- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,761.00 / $8,247.00
| Facility | | $1,020.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.00 / $4,573.00 / $5,958.00
| Professional | | $666.00 | $4,573.00 | $5,958.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.82 / $2,746.00 / $13,822.74
| Facility | | $2,299.82 | $2,746.00 | $13,822.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,249.45 / $64,999.35 / $64,999.35
| Professional | | $55,249.45 | $64,999.35 | $64,999.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.00 / $800.00 / $2,269.00
| Facility | | $495.00 | $800.00 | $2,269.00 |
- 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
- $1,385.97 / $1,385.97 / $1,385.97
| Facility | | $1,385.97 | $1,385.97 | $1,385.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.50 / $306.50 / $306.50
| Professional | | $306.50 | $306.50 | $306.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $4,761.00 / $8,247.00
| Facility | | $1,013.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.00 / $1,200.00 / $7,799.00
| Professional | | $422.00 | $1,200.00 | $7,799.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.00 / $800.00 / $2,269.00
| Facility | | $495.00 | $800.00 | $2,269.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.00 / $552.00 / $552.00
| Professional | | $552.00 | $552.00 | $552.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.00 / $1,077.00 / $3,000.00
| Facility | | $325.00 | $1,077.00 | $3,000.00 |