- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.67 / $2,747.00 / $6,075.00
| Facility | | $1,341.67 | $2,747.00 | $6,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.82 / $947.18 / $2,422.31
| Professional | | $787.82 | $947.18 | $2,422.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,019.68 / $4,329.95 / $28,594.87
| Facility | | $1,019.68 | $4,329.95 | $28,594.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.77 / $1,543.68 / $11,680.42
| Professional | | $919.77 | $1,543.68 | $11,680.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,316.68 / $1,799.35 / $2,437.50
| Professional | | $1,316.68 | $1,799.35 | $2,437.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.83 / $1,472.17 / $2,649.91
| Professional | | $937.83 | $1,472.17 | $2,649.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,500.51 / $8,090.00
| Facility | | $300.00 | $1,500.51 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,062.60 / $1,287.17 / $1,760.60
| Professional | | $1,062.60 | $1,287.17 | $1,760.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.25 / $2,183.96 / $2,874.78
| Professional | | $1,154.25 | $2,183.96 | $2,874.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,097.00 / $14,018.00
| Facility | | $55.00 | $5,097.00 | $14,018.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.37 / $1,699.76 / $11,680.42
| Professional | | $979.37 | $1,699.76 | $11,680.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.36 / $1,417.54 / $2,987.97
| Professional | | $962.36 | $1,417.54 | $2,987.97 |