- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,128.61 / $7,413.10
| Facility | | $1,412.54 | $5,128.61 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $501.19 / $1,318.26
| Professional | | $371.54 | $501.19 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $478.63 / $776.25
| Professional | | $371.54 | $478.63 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,162.28 / $6,918.31
| Facility | | $1,230.27 | $3,162.28 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $707.95 / $1,000.00
| Professional | | $407.38 | $707.95 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $691.83 / $1,230.27
| Professional | | $457.09 | $691.83 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $457.09 / $1,819.70
| Professional | | $354.81 | $457.09 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $933.25 / $933.25 / $933.25
| Professional | 22 | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,168.69 / $6,918.31
| Facility | | $1,122.02 | $4,168.69 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $616.60 / $1,023.29
| Professional | | $407.38 | $616.60 | $1,023.29 |