- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.34 / $2,747.00 / $5,011.00
| Facility | | $657.34 | $2,747.00 | $5,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.58 / $693.19 / $1,016.66
| Professional | | $606.58 | $693.19 | $1,016.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $4,671.00 / $16,223.75
| Facility | | $1,697.00 | $4,671.00 | $16,223.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.83 / $1,215.58 / $4,765.76
| Professional | | $759.83 | $1,215.58 | $4,765.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,920.89 / $3,337.32 / $3,337.32
| Professional | | $2,920.89 | $3,337.32 | $3,337.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $6,366.94
| Facility | | $680.00 | $748.00 | $6,366.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.48 / $1,116.21 / $2,326.84
| Professional | | $627.48 | $1,116.21 | $2,326.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.70 / $1,418.72 / $6,679.00
| Facility | | $660.70 | $1,418.72 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.15 / $958.02 / $1,443.29
| Professional | | $758.15 | $958.02 | $1,443.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $833.54 / $1,645.41 / $2,076.01
| Professional | | $833.54 | $1,645.41 | $2,076.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $4,671.00 / $16,223.75
| Facility | | $1,697.00 | $4,671.00 | $16,223.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.83 / $1,202.48 / $4,765.76
| Professional | | $759.83 | $1,202.48 | $4,765.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $4,671.00 / $13,017.00
| Facility | | $1,697.00 | $4,671.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.81 / $1,107.76 / $2,261.07
| Professional | | $724.81 | $1,107.76 | $2,261.07 |