- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.48 / $2,747.00 / $5,011.00
| Facility | | $663.48 | $2,747.00 | $5,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.67 / $736.37 / $968.18
| Professional | | $627.67 | $736.37 | $968.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.63 / $4,983.00 / $26,542.00
| Facility | | $1,170.63 | $4,983.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $751.14 / $1,413.87 / $5,228.32
| Professional | | $751.14 | $1,413.87 | $5,228.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.65 / $1,399.18 / $1,895.41
| Professional | | $943.65 | $1,399.18 | $1,895.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.00 / $920.70 / $3,751.11
| Facility | | $837.00 | $920.70 | $3,751.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.42 / $1,194.25 / $2,552.46
| Professional | | $641.42 | $1,194.25 | $2,552.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.00 / $1,555.74 / $6,679.00
| Facility | | $506.00 | $1,555.74 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.62 / $1,050.83 / $1,543.65
| Professional | | $831.62 | $1,050.83 | $1,543.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.64 / $1,805.50 / $2,278.00
| Professional | | $914.64 | $1,805.50 | $2,278.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.27 / $1,160.27 / $1,160.27
| Professional | | $1,160.27 | $1,160.27 | $1,160.27 |
- 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
- $794.32 / $1,446.95 / $5,228.32
| Professional | | $794.32 | $1,446.95 | $5,228.32 |
- 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
- $766.42 / $1,114.03 / $3,026.93
| Professional | | $766.42 | $1,114.03 | $3,026.93 |