- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $2,884.03 / $5,623.41
| Facility | | $426.58 | $2,884.03 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $501.19 / $1,479.11
| Professional | | $323.59 | $501.19 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,897.79 / $28,840.32
| Facility | | $812.83 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $588.84 / $1,513.56
| Professional | | $354.81 | $588.84 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $933.25
| Facility | | $407.38 | $407.38 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,023.29 / $1,023.29
| Professional | | $707.95 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $645.65 / $1,230.27
| Professional | | $338.84 | $645.65 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $724.44 / $7,079.46
| Facility | | $331.13 | $724.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $741.31 / $1,000.00
| Professional | | $602.56 | $741.31 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $691.83 / $1,348.96
| Professional | | $398.11 | $691.83 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,951.21 / $3,388.44
| Facility | | $831.76 | $2,951.21 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,897.79 / $28,840.32
| Facility | | $812.83 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $588.84 / $1,513.56
| Professional | | $354.81 | $588.84 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,549.93
| Facility | | $1,862.09 | $4,265.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $630.96 / $1,318.26
| Professional | | $354.81 | $630.96 | $1,318.26 |