- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.00 / $5,176.00 / $10,296.00
| Facility | | $1,819.00 | $5,176.00 | $10,296.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.00 / $493.71 / $562.24
| Professional | | $420.00 | $493.71 | $562.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.18 / $40.18 / $53.58
| Professional | | $40.18 | $40.18 | $53.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.30 / $771.30 / $4,050.00
| Facility | | $771.30 | $771.30 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.30 / $771.30 / $771.30
| Professional | | $771.30 | $771.30 | $771.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $615.85 / $615.85 / $7,227.90
| Facility | | $615.85 | $615.85 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.76 / $1,101.01 / $1,854.43
| Professional | | $603.76 | $1,101.01 | $1,854.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,364.00 / $8,640.00 / $11,153.00
| Facility | | $8,364.00 | $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
- $257.30 / $257.30 / $257.30
| Facility | | $257.30 | $257.30 | $257.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $615.85 / $7,227.90
| Facility | | $555.00 | $615.85 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $615.54 / $1,842.05
| Professional | | $75.00 | $615.54 | $1,842.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,079.00 / $2,826.00 / $4,851.00
| Facility | | $1,079.00 | $2,826.00 | $4,851.00 |