- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $2,371.00 / $7,629.00
| Facility | | $882.00 | $2,371.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.75 / $792.62 / $1,142.95
| Professional | | $529.75 | $792.62 | $1,142.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $989.08 / $989.08 / $989.08
| Facility | | $989.08 | $989.08 | $989.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,832.91 / $2,832.91 / $2,832.91
| Professional | | $2,832.91 | $2,832.91 | $2,832.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.00 / $964.00 / $964.00
| Professional | | $964.00 | $964.00 | $964.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $2,326.00 / $8,017.00
| Facility | | $657.00 | $2,326.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.61 / $885.44 / $5,958.00
| Professional | | $560.61 | $885.44 | $5,958.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $989.08 / $989.08 / $989.08
| Facility | | $989.08 | $989.08 | $989.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,832.91 / $2,832.91 / $2,832.91
| Professional | | $2,832.91 | $2,832.91 | $2,832.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.31 / $1,007.31 / $1,109.15
| Facility | | $1,007.31 | $1,007.31 | $1,109.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.31 / $1,085.81 / $1,109.15
| Professional | | $1,007.31 | $1,085.81 | $1,109.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.00 / $650.00 / $3,742.00
| Facility | | $162.00 | $650.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.88 / $768.32 / $1,438.43
| Professional | | $477.88 | $768.32 | $1,438.43 |