- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.08 / $2,079.00 / $3,625.00
| Facility | | $626.08 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.74 / $589.44 / $966.57
| Professional | | $347.74 | $589.44 | $966.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.99 / $2,854.00 / $9,039.00
| Facility | | $820.99 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.05 / $1,125.46 / $6,251.76
| Professional | | $462.05 | $1,125.46 | $6,251.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.19 / $637.60 / $1,265.28
| Facility | | $496.19 | $637.60 | $1,265.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.45 / $909.72 / $1,714.24
| Professional | | $463.45 | $909.72 | $1,714.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.31 / $904.76 / $6,679.00
| Facility | | $418.31 | $904.76 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,024.27 / $1,249.65 / $1,737.95
| Professional | | $1,024.27 | $1,249.65 | $1,737.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.10 / $1,183.65 / $2,639.82
| Professional | | $559.10 | $1,183.65 | $2,639.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,718.81 / $1,718.81 / $1,718.81
| Facility | | $1,718.81 | $1,718.81 | $1,718.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $12,000.00
| Facility | | $1,902.00 | $3,764.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.02 / $1,430.96 / $6,251.76
| Professional | | $685.02 | $1,430.96 | $6,251.76 |
- 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
- $609.62 / $1,069.84 / $2,510.05
| Professional | | $609.62 | $1,069.84 | $2,510.05 |