- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $538.55 / $2,822.00 / $6,075.00
| Facility | | $538.55 | $2,822.00 | $6,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.26 / $566.54 / $787.49
| Professional | | $481.26 | $566.54 | $787.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.79 / $4,628.72 / $26,542.00
| Facility | | $1,387.79 | $4,628.72 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.39 / $1,150.19 / $8,481.71
| Professional | | $602.39 | $1,150.19 | $8,481.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.02 / $3,212.69 / $3,212.69
| Professional | | $974.02 | $3,212.69 | $3,212.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.00 / $1,051.59 / $6,493.89
| Facility | | $956.00 | $1,051.59 | $6,493.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.92 / $921.55 / $1,818.90
| Professional | | $516.92 | $921.55 | $1,818.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.98 / $1,261.74 / $6,679.00
| Facility | | $580.98 | $1,261.74 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.67 / $851.67 / $1,278.40
| Professional | | $666.67 | $851.67 | $1,278.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.85 / $1,419.01 / $1,832.35
| Professional | | $718.85 | $1,419.01 | $1,832.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $6,204.00 / $26,542.00
| Facility | | $1,591.00 | $6,204.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.12 / $1,163.17 / $8,481.71
| Professional | | $646.12 | $1,163.17 | $8,481.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,006.00 / $10,764.00
| Facility | | $1,591.00 | $4,006.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.16 / $883.20 / $2,042.19
| Professional | | $613.16 | $883.20 | $2,042.19 |