- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,566.00 / $8,774.00 / $20,135.00
| Facility | | $3,566.00 | $8,774.00 | $20,135.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,382.00 / $18,028.12 / $18,028.12
| Professional | | $5,382.00 | $18,028.12 | $18,028.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,437.00 / $10,474.00 / $20,418.00
| Facility | | $4,437.00 | $10,474.00 | $20,418.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.00 / $317.00 / $330.00
| Professional | | $298.00 | $317.00 | $330.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.09 / $100.00 / $13,849.19
| Facility | | $66.09 | $100.00 | $13,849.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,010.71 / $15,010.71 / $17,739.93
| Facility | | $15,010.71 | $15,010.71 | $17,739.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.58 / $356.58 / $356.58
| Professional | | $356.58 | $356.58 | $356.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,659.41 / $16,659.41 / $17,492.39
| Professional | | $16,659.41 | $16,659.41 | $17,492.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.93 / $393.93 / $393.93
| Professional | | $393.93 | $393.93 | $393.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,010.71 / $15,010.71 / $17,739.93
| Facility | | $15,010.71 | $15,010.71 | $17,739.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.58 / $356.58 / $356.58
| Professional | | $356.58 | $356.58 | $356.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,830.00 / $18,315.00 / $45,545.00
| Facility | | $8,830.00 | $18,315.00 | $45,545.00 |