- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,516.00 / $5,845.00 / $10,686.00
| Facility | | $1,516.00 | $5,845.00 | $10,686.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.92 / $362.50 / $406.92
| Professional | | $227.92 | $362.50 | $406.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,568.00 / $7,578.00 / $14,193.00
| Facility | | $4,568.00 | $7,578.00 | $14,193.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.71 / $1,265.11 / $2,557.17
| Professional | | $1,006.71 | $1,265.11 | $2,557.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,499.62 / $37,499.62 / $37,499.62
| Facility | | $37,499.62 | $37,499.62 | $37,499.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.90 / $357.90 / $7,227.90
| Facility | | $357.90 | $357.90 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.04 / $1,490.49 / $1,490.49
| Professional | | $299.04 | $1,490.49 | $1,490.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.02 / $393.25 / $634.66
| Professional | | $294.02 | $393.25 | $634.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.90 / $555.00 / $7,227.90
| Facility | | $357.90 | $555.00 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.04 / $1,490.49 / $1,490.49
| Professional | | $299.04 | $1,490.49 | $1,490.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.44 / $417.38 / $1,067.93
| Professional | | $279.44 | $417.38 | $1,067.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.52 / $302.52 / $316.55
| Facility | | $302.52 | $302.52 | $316.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.52 / $316.55 / $634.66
| Professional | | $302.52 | $316.55 | $634.66 |