- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.94 / $2,747.00 / $5,039.00
| Facility | | $583.94 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.09 / $606.88 / $950.65
| Professional | | $522.09 | $606.88 | $950.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.63 / $3,425.34 / $26,542.00
| Facility | | $1,170.63 | $3,425.34 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.04 / $1,185.58 / $4,724.88
| Professional | | $617.04 | $1,185.58 | $4,724.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,818.99 / $2,140.21 / $2,140.21
| Professional | | $1,818.99 | $2,140.21 | $2,140.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $1,947.00 / $3,751.11
| Facility | | $1,770.00 | $1,947.00 | $3,751.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.03 / $996.07 / $2,112.21
| Professional | | $494.03 | $996.07 | $2,112.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.00 / $1,291.11 / $6,679.00
| Facility | | $506.00 | $1,291.11 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.37 / $871.51 / $1,279.61
| Professional | | $689.37 | $871.51 | $1,279.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.35 / $1,495.01 / $1,886.26
| Professional | | $757.35 | $1,495.01 | $1,886.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $5,572.00 / $26,542.00
| Facility | | $1,485.00 | $5,572.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.53 / $1,194.50 / $4,724.88
| Professional | | $652.53 | $1,194.50 | $4,724.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $3,245.00 / $7,608.00
| Facility | | $1,485.00 | $3,245.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.70 / $892.53 / $2,062.35
| Professional | | $624.70 | $892.53 | $2,062.35 |