- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.00 / $3,839.00 / $8,017.00
| Facility | | $768.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.50 / $367.50 / $482.08
| Professional | | $367.50 | $367.50 | $482.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.26 / $342.73 / $342.73
| Professional | | $330.26 | $342.73 | $342.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.00 / $330.63 / $1,585.87
| Professional | | $126.00 | $330.63 | $1,585.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,211.74 / $8,211.74 / $8,211.74
| Facility | | $8,211.74 | $8,211.74 | $8,211.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,905.66 / $8,017.00
| Facility | | $954.00 | $3,905.66 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.50 / $367.50 / $2,843.00
| Professional | | $367.50 | $367.50 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $879.00 / $879.00 / $879.00
| Professional | | $879.00 | $879.00 | $879.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.63 / $1,323.64 / $2,493.59
| Professional | | $330.63 | $1,323.64 | $2,493.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $415.84 / $415.84 / $415.84
| Facility | | $415.84 | $415.84 | $415.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.84 / $415.84 / $415.84
| Professional | | $415.84 | $415.84 | $415.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.00 / $2,974.56 / $6,195.30
| Facility | | $912.00 | $2,974.56 | $6,195.30 |