- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.80 / $2,747.00 / $5,990.92
| Facility | | $1,636.80 | $2,747.00 | $5,990.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.53 / $473.62 / $2,082.35
| Professional | | $385.53 | $473.62 | $2,082.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.60 / $5,268.00 / $15,220.00
| Facility | | $748.60 | $5,268.00 | $15,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.00 / $620.33 / $4,770.00
| Professional | | $333.00 | $620.33 | $4,770.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.08 / $237.43 / $949.73
| Professional | | $113.08 | $237.43 | $949.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.76 / $631.28 / $1,144.14
| Professional | | $354.76 | $631.28 | $1,144.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.39 / $647.36 / $6,679.00
| Facility | | $304.39 | $647.36 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.60 / $357.67 / $563.12
| Professional | | $187.60 | $357.67 | $563.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.98 / $763.82 / $1,116.86
| Professional | | $382.98 | $763.82 | $1,116.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,281.48 / $4,959.89 / $5,142.85
| Facility | | $3,281.48 | $4,959.89 | $5,142.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.95 / $955.95 / $955.95
| Professional | | $955.95 | $955.95 | $955.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $6,104.00 / $26,542.00
| Facility | | $1,485.00 | $6,104.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.58 / $647.36 / $4,770.00
| Professional | | $416.58 | $647.36 | $4,770.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.46 / $583.21 / $1,067.86
| Professional | | $409.46 | $583.21 | $1,067.86 |