- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.75 / $6,534.00 / $15,370.93
| Facility | | $981.75 | $6,534.00 | $15,370.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.00 / $981.75 / $981.75
| Professional | | $924.00 | $981.75 | $981.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.66 / $1,097.25 / $8,459.92
| Facility | | $932.66 | $1,097.25 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.25 / $1,097.25 / $1,097.25
| Professional | | $1,097.25 | $1,097.25 | $1,097.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.75 / $981.75 / $981.75
| Facility | | $981.75 | $981.75 | $981.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.75 / $981.75 / $981.75
| Professional | | $981.75 | $981.75 | $981.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $834.49 / $981.75 / $981.75
| Professional | | $834.49 | $981.75 | $981.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.61 / $1,183.24 / $3,331.53
| Facility | | $1,047.61 | $1,183.24 | $3,331.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,246.82 / $7,905.01 / $15,382.02
| Facility | | $1,246.82 | $7,905.01 | $15,382.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $947.10 / $981.75 / $1,079.92
| Professional | | $947.10 | $981.75 | $1,079.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,194.09 / $2,660.24 / $4,119.82
| Professional | | $1,194.09 | $2,660.24 | $4,119.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.75 / $981.75 / $981.75
| Facility | | $981.75 | $981.75 | $981.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.75 / $981.75 / $981.75
| Professional | | $981.75 | $981.75 | $981.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,054.50 / $1,054.50 / $1,159.95
| Facility | | $1,054.50 | $1,054.50 | $1,159.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.50 / $1,054.50 / $1,159.95
| Professional | | $1,054.50 | $1,054.50 | $1,159.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.50 / $962.50 / $1,329.21
| Professional | | $962.50 | $962.50 | $1,329.21 |