- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $901.98 / $4,264.00 / $8,240.00
| Facility | | $901.98 | $4,264.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.23 / $845.04 / $1,094.49
| Professional | | $684.23 | $845.04 | $1,094.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.61 / $1,073.90 / $1,447.46
| Professional | | $717.61 | $1,073.90 | $1,447.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.24 / $1,018.74 / $1,608.01
| Professional | | $717.24 | $1,018.74 | $1,608.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.45 / $1,292.77 / $1,308.76
| Professional | | $974.45 | $1,292.77 | $1,308.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $4,761.00 / $8,247.00
| Facility | | $1,013.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.00 / $879.05 / $4,232.75
| Professional | | $700.00 | $879.05 | $4,232.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $868.70 / $2,193.19
| Professional | | $5.00 | $868.70 | $2,193.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.58 / $1,025.31 / $1,699.04
| Professional | | $793.58 | $1,025.31 | $1,699.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.01 / $813.63 / $813.63
| Facility | | $811.01 | $813.63 | $813.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.47 / $813.63 / $867.80
| Professional | | $795.47 | $813.63 | $867.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,914.00 / $7,000.00
| Facility | | $2,332.00 | $3,914.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672.81 / $951.70 / $1,582.61
| Professional | | $672.81 | $951.70 | $1,582.61 |