- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.54 / $1,245.00 / $10,453.00
| Facility | | $533.54 | $1,245.00 | $10,453.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.54 / $631.16 / $1,174.14
| Professional | | $533.54 | $631.16 | $1,174.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,920.34 / $1,920.34 / $1,948.36
| Facility | | $1,920.34 | $1,920.34 | $1,948.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.00 / $993.02 / $1,930.30
| Professional | | $295.00 | $993.02 | $1,930.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $2,393.27
| Facility | | $748.70 | $748.70 | $2,393.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.07 / $854.34 / $1,682.50
| Professional | | $628.07 | $854.34 | $1,682.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.54 / $750.85 / $1,276.79
| Facility | | $533.54 | $750.85 | $1,276.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.00 / $1,055.00 / $1,055.00
| Professional | | $716.00 | $1,055.00 | $1,055.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $861.40 / $2,183.69
| Professional | | $5.00 | $861.40 | $2,183.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.38 / $864.80 / $1,730.32
| Professional | | $595.38 | $864.80 | $1,730.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,791.10 / $3,791.10 / $26,542.00
| Facility | | $3,791.10 | $3,791.10 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,008.16 / $4,721.60 / $5,455.58
| Professional | | $4,008.16 | $4,721.60 | $5,455.58 |