- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.84 / $2,663.12 / $4,410.00
| Facility | | $556.84 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.92 / $560.62 / $1,256.72
| Professional | | $417.92 | $560.62 | $1,256.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,242.17 / $5,063.00 / $16,742.00
| Facility | | $1,242.17 | $5,063.00 | $16,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.22 / $1,267.39 / $4,669.60
| Professional | | $513.22 | $1,267.39 | $4,669.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.13 / $806.17 / $1,422.58
| Facility | | $620.13 | $806.17 | $1,422.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.84 / $1,302.43 / $2,419.38
| Professional | | $760.84 | $1,302.43 | $2,419.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.37 / $1,130.74 / $6,679.00
| Facility | | $519.37 | $1,130.74 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $747.21 / $944.18 / $1,688.13
| Professional | | $747.21 | $944.18 | $1,688.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.27 / $1,373.10 / $1,764.14
| Professional | | $653.27 | $1,373.10 | $1,764.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $6,204.00 / $26,542.00
| Facility | | $2,324.00 | $6,204.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.41 / $1,630.48 / $4,669.60
| Professional | | $755.41 | $1,630.48 | $4,669.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.65 / $1,089.68 / $2,453.84
| Professional | | $649.65 | $1,089.68 | $2,453.84 |