- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.15 / $4,746.91 / $10,924.00
| Facility | | $981.15 | $4,746.91 | $10,924.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.70 / $1,026.67 / $2,561.92
| Professional | | $964.70 | $1,026.67 | $2,561.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,474.86 / $3,474.86 / $3,525.56
| Facility | | $3,474.86 | $3,474.86 | $3,525.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.58 / $1,779.23 / $2,588.73
| Professional | | $1,144.58 | $1,779.23 | $2,588.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $5,006.99
| Facility | | $530.04 | $530.04 | $5,006.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,082.21 / $1,452.28 / $2,662.70
| Professional | | $1,082.21 | $1,452.28 | $2,662.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.15 / $1,250.34 / $2,035.98
| Facility | | $981.15 | $1,250.34 | $2,035.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.00 / $1,404.00 / $1,404.00
| Professional | | $507.00 | $1,404.00 | $1,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,287.30 / $2,948.40
| Professional | | $5.00 | $1,287.30 | $2,948.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.72 / $1,250.06 / $2,587.75
| Professional | | $900.72 | $1,250.06 | $2,587.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,459.52 / $16,394.00 / $16,547.20
| Facility | | $5,459.52 | $16,394.00 | $16,547.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,057.00 / $9,057.00 / $9,057.00
| Professional | | $9,057.00 | $9,057.00 | $9,057.00 |