- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,733.00 / $4,712.00
| Facility | | $1,758.00 | $2,733.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.53 / $446.62 / $702.75
| Professional | | $408.53 | $446.62 | $702.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.39 / $3,818.90 / $12,379.00
| Facility | | $960.39 | $3,818.90 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.74 / $800.53 / $3,341.83
| Professional | | $384.74 | $800.53 | $3,341.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.40 / $827.28 / $1,525.45
| Professional | | $481.40 | $827.28 | $1,525.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.16 / $877.66 / $6,679.00
| Facility | | $409.16 | $877.66 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.17 / $469.51 / $756.95
| Professional | | $252.17 | $469.51 | $756.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.90 / $1,012.96 / $1,471.64
| Professional | | $507.90 | $1,012.96 | $1,471.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.98 / $330.98 / $330.98
| Professional | | $330.98 | $330.98 | $330.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.92 / $4,525.00 / $26,542.00
| Facility | | $1,518.92 | $4,525.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.82 / $898.41 / $3,341.83
| Professional | | $467.82 | $898.41 | $3,341.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.39 / $664.16 / $1,453.61
| Professional | | $437.39 | $664.16 | $1,453.61 |