- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,618.00 / $3,107.00 / $8,271.00
| Facility | | $2,618.00 | $3,107.00 | $8,271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.22 / $997.57 / $2,584.57
| Professional | | $925.22 | $997.57 | $2,584.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $3,887.00 / $13,017.00
| Facility | | $818.35 | $3,887.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,003.22 / $1,901.30 / $10,000.00
| Professional | | $1,003.22 | $1,901.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,164.21 / $2,021.78 / $3,728.04
| Professional | | $1,164.21 | $2,021.78 | $3,728.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,593.35 / $8,090.00
| Facility | | $300.00 | $1,593.35 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.86 / $1,135.51 / $1,830.67
| Professional | | $609.86 | $1,135.51 | $1,830.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,234.94 / $2,448.15 / $3,108.34
| Professional | | $1,234.94 | $2,448.15 | $3,108.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.66 / $315.66 / $315.66
| Professional | | $315.66 | $315.66 | $315.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $6,078.00 / $14,018.00
| Facility | | $55.00 | $6,078.00 | $14,018.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,107.82 / $2,066.65 / $10,000.00
| Professional | | $1,107.82 | $2,066.65 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,095.01 / $1,427.73 / $3,383.83
| Professional | | $1,095.01 | $1,427.73 | $3,383.83 |