- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.00 / $5,699.00 / $13,744.82
| Facility | | $1,819.00 | $5,699.00 | $13,744.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,085.10 / $1,085.11 / $1,193.63
| Professional | | $1,085.10 | $1,085.11 | $1,193.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,499.00 / $7,264.00 / $13,780.00
| Facility | | $4,499.00 | $7,264.00 | $13,780.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.61 / $820.32 / $6,067.53
| Professional | | $685.61 | $820.32 | $6,067.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,652.50 / $3,652.50 / $10,957.50
| Facility | | $3,652.50 | $3,652.50 | $10,957.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,538.00 / $7,227.90 / $12,209.00
| Facility | | $1,538.00 | $7,227.90 | $12,209.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.00 / $3,562.26 / $3,562.26
| Professional | | $929.00 | $3,562.26 | $3,562.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,813.00 / $8,640.00 / $11,153.00
| Facility | | $2,813.00 | $8,640.00 | $11,153.00 |
- 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
- $7,819.65 / $9,953.01 / $12,672.94
| Facility | | $7,819.65 | $9,953.01 | $12,672.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $7,227.90 / $12,209.00
| Facility | | $555.00 | $7,227.90 | $12,209.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.00 / $3,562.26 / $3,562.26
| Professional | | $929.00 | $3,562.26 | $3,562.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,220.00 / $5,734.00 / $14,881.00
| Facility | | $2,220.00 | $5,734.00 | $14,881.00 |