- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,201.84 / $4,048.00 / $8,451.00
| Facility | | $1,201.84 | $4,048.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.47 / $1,201.84 / $1,395.28
| Professional | | $810.47 | $1,201.84 | $1,395.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,555.88 / $1,555.88 / $1,555.88
| Facility | | $1,555.88 | $1,555.88 | $1,555.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,478.08 / $6,478.08 / $6,478.08
| Professional | | $6,478.08 | $6,478.08 | $6,478.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,840.58 / $1,840.58 / $1,840.58
| Professional | | $1,840.58 | $1,840.58 | $1,840.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $4,993.00 / $10,247.00
| Facility | | $1,151.00 | $4,993.00 | $10,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.47 / $1,301.10 / $2,660.00
| Professional | | $810.47 | $1,301.10 | $2,660.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $10.00
| Professional | | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,555.88 / $1,555.88 / $1,555.88
| Facility | | $1,555.88 | $1,555.88 | $1,555.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,478.08 / $6,478.08 / $6,478.08
| Professional | | $6,478.08 | $6,478.08 | $6,478.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,330.03 / $1,330.03 / $1,464.50
| Facility | | $1,330.03 | $1,330.03 | $1,464.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.03 / $1,410.99 / $1,464.50
| Professional | | $1,330.03 | $1,410.99 | $1,464.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,228.00 / $4,563.00 / $8,261.00
| Facility | | $2,228.00 | $4,563.00 | $8,261.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,317.65 / $1,730.77 / $2,643.12
| Professional | | $1,317.65 | $1,730.77 | $2,643.12 |