- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $636.78 / $2,618.00 / $3,625.00
| Facility | | $636.78 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.95 / $698.39 / $1,967.13
| Professional | | $552.95 | $698.39 | $1,967.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $5,209.26 / $9,401.00
| Facility | | $1,672.00 | $5,209.26 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.12 / $1,335.51 / $5,508.64
| Professional | | $669.12 | $1,335.51 | $5,508.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.79 / $1,163.23 / $2,052.65
| Facility | | $894.79 | $1,163.23 | $2,052.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.09 / $1,308.45 / $2,864.88
| Professional | | $836.09 | $1,308.45 | $2,864.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.59 / $1,631.56 / $6,679.00
| Facility | | $756.59 | $1,631.56 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $963.07 / $1,205.50 / $1,664.06
| Professional | | $963.07 | $1,205.50 | $1,664.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.57 / $1,888.27 / $2,667.86
| Professional | | $937.57 | $1,888.27 | $2,667.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.71 / $524.71 / $524.71
| Facility | | $524.71 | $524.71 | $524.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,209.26 / $16,394.00
| Facility | | $2,155.00 | $5,209.26 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.62 / $1,592.82 / $6,307.92
| Professional | | $937.62 | $1,592.82 | $6,307.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.89 / $1,237.04 / $2,671.55
| Professional | | $799.89 | $1,237.04 | $2,671.55 |