- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.84 / $2,663.12 / $4,712.00
| Facility | | $986.84 | $2,663.12 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.24 / $864.25 / $2,059.75
| Professional | | $224.24 | $864.25 | $2,059.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.87 / $6,078.00 / $26,542.00
| Facility | | $787.87 | $6,078.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.06 / $1,703.70 / $5,879.92
| Professional | | $353.06 | $1,703.70 | $5,879.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.71 / $493.62 / $968.26
| Facility | | $379.71 | $493.62 | $968.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.52 / $1,699.56 / $3,940.87
| Professional | | $582.52 | $1,699.56 | $3,940.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.22 / $692.36 / $6,679.00
| Facility | | $322.22 | $692.36 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,363.57 / $1,608.30 / $2,875.52
| Professional | | $1,363.57 | $1,608.30 | $2,875.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.32 / $1,345.54 / $3,351.20
| Professional | | $406.32 | $1,345.54 | $3,351.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,057.07 / $6,883.00 / $26,542.00
| Facility | | $2,057.07 | $6,883.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,478.60 / $3,014.24 / $7,793.44
| Professional | | $1,478.60 | $3,014.24 | $7,793.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.80 / $1,995.61 / $4,049.19
| Professional | | $1,059.80 | $1,995.61 | $4,049.19 |