- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.32 / $2,618.00 / $4,767.00
| Facility | | $466.32 | $2,618.00 | $4,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.61 / $502.02 / $1,294.08
| Professional | | $303.61 | $502.02 | $1,294.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.56 / $2,376.00 / $8,498.00
| Facility | | $791.56 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.44 / $840.37 / $3,777.20
| Professional | | $373.44 | $840.37 | $3,777.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.28 / $511.79 / $913.65
| Facility | | $398.28 | $511.79 | $913.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.96 / $770.46 / $1,212.38
| Professional | | $517.96 | $770.46 | $1,212.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.12 / $718.82 / $1,368.68
| Professional | | $412.12 | $718.82 | $1,368.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $334.77 / $726.22 / $6,679.00
| Facility | | $334.77 | $726.22 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.19 / $744.46 / $1,030.23
| Professional | | $610.19 | $744.46 | $1,030.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.53 / $917.87 / $1,529.41
| Professional | | $436.53 | $917.87 | $1,529.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,867.80 / $2,867.80 / $5,190.76
| Facility | | $2,867.80 | $2,867.80 | $5,190.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.00 / $524.10 / $1,138.95
| Professional | | $346.00 | $524.10 | $1,138.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $16,394.00
| Facility | | $1,640.00 | $3,372.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.42 / $1,070.11 / $3,777.20
| Professional | | $543.42 | $1,070.11 | $3,777.20 |
- 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
- $517.76 / $815.12 / $1,609.53
| Professional | | $517.76 | $815.12 | $1,609.53 |