- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.24 / $2,618.00 / $5,003.00
| Facility | | $521.24 | $2,618.00 | $5,003.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.24 / $498.86 / $814.94
| Professional | | $340.24 | $498.86 | $814.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $854.10 / $2,854.00 / $9,039.00
| Facility | | $854.10 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.64 / $868.98 / $3,735.84
| Professional | | $399.64 | $868.98 | $3,735.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.99 / $552.54 / $986.40
| Facility | | $429.99 | $552.54 | $986.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.10 / $1,007.35 / $1,067.24
| Professional | | $705.10 | $1,007.35 | $1,067.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.75 / $763.17 / $1,448.15
| Professional | | $460.75 | $763.17 | $1,448.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.94 / $784.04 / $6,679.00
| Facility | | $365.94 | $784.04 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.82 / $715.68 / $985.71
| Professional | | $590.82 | $715.68 | $985.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.47 / $993.85 / $1,469.24
| Professional | | $472.47 | $993.85 | $1,469.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,844.38 / $3,764.00 / $26,542.00
| Facility | | $1,844.38 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.69 / $1,120.11 / $3,735.84
| Professional | | $591.69 | $1,120.11 | $3,735.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,997.00 / $8,766.00
| Facility | | $1,902.00 | $3,997.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.97 / $833.67 / $1,727.85
| Professional | | $560.97 | $833.67 | $1,727.85 |