- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.37 / $2,618.00 / $3,625.00
| Facility | | $501.37 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.32 / $501.37 / $1,027.78
| Professional | | $358.32 | $501.37 | $1,027.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.57 / $2,854.00 / $9,039.00
| Facility | | $935.57 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.40 / $905.72 / $4,825.49
| Professional | | $434.40 | $905.72 | $4,825.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.50 / $596.88 / $1,065.56
| Facility | | $464.50 | $596.88 | $1,065.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.01 / $887.06 / $1,304.19
| Professional | | $628.01 | $887.06 | $1,304.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.40 / $808.41 / $1,492.40
| Professional | | $490.40 | $808.41 | $1,492.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.27 / $846.98 / $6,679.00
| Facility | | $391.27 | $846.98 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.60 / $730.00 / $1,007.69
| Professional | | $600.60 | $730.00 | $1,007.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.09 / $1,055.68 / $1,512.21
| Professional | | $497.09 | $1,055.68 | $1,512.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.27 / $607.27 / $964.12
| Professional | | $607.27 | $607.27 | $964.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $16,394.00
| Facility | | $1,902.00 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.58 / $1,162.40 / $4,825.49
| Professional | | $594.58 | $1,162.40 | $4,825.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.03 / $871.15 / $1,600.61
| Professional | | $574.03 | $871.15 | $1,600.61 |