- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,259.76 / $5,636.00 / $15,857.51
| Facility | | $1,259.76 | $5,636.00 | $15,857.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.83 / $1,637.15 / $3,109.96
| Professional | | $737.83 | $1,637.15 | $3,109.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,153.00 / $7,363.00 / $9,410.00
| Facility | | $6,153.00 | $7,363.00 | $9,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.76 / $1,353.91 / $2,193.23
| Professional | | $683.76 | $1,353.91 | $2,193.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.43 / $1,101.82 / $8,031.00
| Professional | | $764.43 | $1,101.82 | $8,031.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.38 / $1,620.66 / $3,955.67
| Professional | | $733.38 | $1,620.66 | $3,955.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,482.92 / $1,779.50 / $2,194.71
| Professional | | $1,482.92 | $1,779.50 | $2,194.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.19 / $1,608.03 / $3,203.56
| Facility | | $783.19 | $1,608.03 | $3,203.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,619.04 / $2,591.57 / $3,765.00
| Professional | | $1,619.04 | $2,591.57 | $3,765.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.79 / $925.93 / $6,585.00
| Facility | | $681.79 | $925.93 | $6,585.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,477.95 / $2,484.92 / $7,420.00
| Professional | | $1,477.95 | $2,484.92 | $7,420.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,693.00 / $11,671.00 / $21,639.00
| Facility | | $6,693.00 | $11,671.00 | $21,639.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,367.84 / $2,456.32 / $3,962.65
| Professional | | $1,367.84 | $2,456.32 | $3,962.65 |