- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.41 / $2,671.00 / $4,712.00
| Facility | | $613.41 | $2,671.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.89 / $729.50 / $1,304.49
| Professional | | $506.89 | $729.50 | $1,304.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $3,315.28 / $8,498.00
| Facility | | $1,089.00 | $3,315.28 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.05 / $1,215.30 / $4,742.56
| Professional | | $597.05 | $1,215.30 | $4,742.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $769.77 / $1,000.70 / $1,765.85
| Facility | | $769.77 | $1,000.70 | $1,765.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $972.22 / $1,381.66 / $1,966.92
| Professional | | $972.22 | $1,381.66 | $1,966.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.36 / $1,186.31 / $2,451.73
| Professional | | $726.36 | $1,186.31 | $2,451.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.50 / $1,403.60 / $6,679.00
| Facility | | $650.50 | $1,403.60 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.26 / $1,093.25 / $1,509.11
| Professional | | $871.26 | $1,093.25 | $1,509.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.04 / $1,653.67 / $2,412.64
| Professional | | $804.04 | $1,653.67 | $2,412.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,822.81 / $3,822.81 / $3,822.81
| Facility | | $3,822.81 | $3,822.81 | $3,822.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $4,476.54 / $26,542.00
| Facility | | $1,640.00 | $4,476.54 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.07 / $1,514.45 / $5,701.68
| Professional | | $855.07 | $1,514.45 | $5,701.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.17 / $1,100.65 / $2,321.44
| Professional | | $721.17 | $1,100.65 | $2,321.44 |