- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.32 / $2,083.00 / $4,170.54
| Facility | | $625.32 | $2,083.00 | $4,170.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.28 / $457.16 / $1,402.56
| Professional | | $128.28 | $457.16 | $1,402.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.78 / $941.10 / $2,796.00
| Facility | | $185.78 | $941.10 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.16 / $1,241.16 / $4,096.91
| Professional | | $178.16 | $1,241.16 | $4,096.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.54 / $250.30 / $490.98
| Facility | | $192.54 | $250.30 | $490.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.58 / $987.98 / $2,051.73
| Professional | | $294.58 | $987.98 | $2,051.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.07 / $1,089.89 / $2,358.86
| Professional | | $262.07 | $1,089.89 | $2,358.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.26 / $263.31 / $6,679.00
| Facility | | $168.26 | $263.31 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.32 / $1,173.15 / $2,097.51
| Professional | | $995.32 | $1,173.15 | $2,097.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.53 / $837.74 / $2,165.65
| Professional | | $210.53 | $837.74 | $2,165.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.02 / $567.02 / $1,386.55
| Facility | | $567.02 | $567.02 | $1,386.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.31 / $132.60 / $265.67
| Professional | | $123.31 | $132.60 | $265.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,475.05 / $3,445.00
| Facility | | $55.00 | $1,475.05 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,053.49 / $2,177.35 / $5,698.08
| Professional | | $1,053.49 | $2,177.35 | $5,698.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.45 / $1,388.73 / $3,137.29
| Professional | | $288.45 | $1,388.73 | $3,137.29 |