- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $839.38 / $2,663.12 / $4,410.00
| Facility | | $839.38 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.00 / $839.38 / $1,772.19
| Professional | | $191.00 | $839.38 | $1,772.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.09 / $5,268.00 / $26,542.00
| Facility | | $674.09 | $5,268.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.08 / $1,740.10 / $5,387.49
| Professional | | $298.08 | $1,740.10 | $5,387.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.73 / $457.25 / $896.91
| Facility | | $351.73 | $457.25 | $896.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.95 / $1,397.91 / $3,347.84
| Professional | | $498.95 | $1,397.91 | $3,347.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $641.34 / $6,679.00
| Facility | | $300.00 | $641.34 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,625.13 / $1,913.31 / $3,418.37
| Professional | | $1,625.13 | $1,913.31 | $3,418.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.60 / $1,593.34 / $3,547.19
| Professional | | $375.60 | $1,593.34 | $3,547.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,715.70 / $5,572.00 / $26,542.00
| Facility | | $1,715.70 | $5,572.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,582.63 / $2,943.56 / $9,242.56
| Professional | | $1,582.63 | $2,943.56 | $9,242.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,268.00 / $9,700.98
| Facility | | $2,155.00 | $5,268.00 | $9,700.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,438.30 / $2,077.54 / $3,883.20
| Professional | | $1,438.30 | $2,077.54 | $3,883.20 |