- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $915.36 / $2,822.00 / $6,075.00
| Facility | | $915.36 | $2,822.00 | $6,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.44 / $966.82 / $1,510.45
| Professional | | $843.44 | $966.82 | $1,510.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $5,063.00 / $26,542.00
| Facility | | $1,591.00 | $5,063.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.71 / $1,735.47 / $9,218.11
| Professional | | $912.71 | $1,735.47 | $9,218.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,089.75 / $1,787.08 / $2,420.88
| Professional | | $1,089.75 | $1,787.08 | $2,420.88 |
- 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
- $704.81 / $1,486.32 / $2,874.73
| Professional | | $704.81 | $1,486.32 | $2,874.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $1,909.00 / $6,679.00
| Facility | | $814.00 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,046.60 / $1,341.27 / $2,034.38
| Professional | | $1,046.60 | $1,341.27 | $2,034.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,121.48 / $2,213.80 / $2,858.65
| Professional | | $1,121.48 | $2,213.80 | $2,858.65 |
- 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
- $1,012.97 / $1,735.47 / $9,218.11
| Professional | | $1,012.97 | $1,735.47 | $9,218.11 |
- 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
- $936.29 / $1,390.94 / $3,056.28
| Professional | | $936.29 | $1,390.94 | $3,056.28 |