- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $4,073.80 / $10,964.78
| Facility | | $537.03 | $4,073.80 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $316.23 / $1,047.13
| Professional | | $229.09 | $316.23 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $229.09 / $288.40
| Professional | | $229.09 | $229.09 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,585.78 / $57,543.99
| Facility | | $6,456.54 | $7,585.78 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $478.63 / $562.34
| Professional | | $371.54 | $478.63 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $316.23 / $478.63
| Professional | | $234.42 | $316.23 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $331.13 / $363.08
| Professional | | $257.04 | $331.13 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $316.23 / $478.63
| Professional | | $239.88 | $316.23 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,317.64 / $15,488.17
| Facility | | $3,162.28 | $8,317.64 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,630.78 / $9,549.93
| Facility | | $575.44 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $346.74 / $1,000.00
| Professional | | $234.42 | $346.74 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $537.03
| Facility | | $478.63 | $478.63 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $467.74 / $537.03
| Professional | | $323.59 | $467.74 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $309.03 / $416.87
| Facility | | $234.42 | $309.03 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $309.03 / $416.87
| Professional | | $229.09 | $309.03 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,548.13 / $10,964.78
| Facility | | $1,348.96 | $3,548.13 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $288.40 / $489.78
| Professional | | $213.80 | $288.40 | $489.78 |