- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.77 / $3,839.00 / $8,427.00
| Facility | | $877.77 | $3,839.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.84 / $809.35 / $1,018.80
| Professional | | $668.84 | $809.35 | $1,018.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,480.74
| Facility | | $13,531.00 | $27,840.00 | $46,480.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.99 / $1,166.26 / $1,503.20
| Professional | | $637.99 | $1,166.26 | $1,503.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.54 / $1,040.72 / $1,509.43
| Professional | | $733.54 | $1,040.72 | $1,509.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.50 / $1,094.50 / $1,154.16
| Professional | | $1,094.50 | $1,094.50 | $1,154.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.77 / $4,761.00 / $8,427.00
| Facility | | $877.77 | $4,761.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.00 / $877.77 / $3,771.80
| Professional | | $700.00 | $877.77 | $3,771.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $1,305.90 / $1,798.40
| Professional | | $20.00 | $1,305.90 | $1,798.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $803.88 / $1,045.04 / $1,659.35
| Professional | | $803.88 | $1,045.04 | $1,659.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $708.48 / $712.00 / $712.00
| Facility | | $708.48 | $712.00 | $712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.55 / $712.00 / $742.68
| Professional | | $679.55 | $712.00 | $742.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.00 / $2,391.00 / $6,322.00
| Facility | | $656.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.47 / $965.16 / $1,510.05
| Professional | | $716.47 | $965.16 | $1,510.05 |