- 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
- $738.42 / $869.84 / $1,297.08
| Professional | | $738.42 | $869.84 | $1,297.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $4,983.00 / $10,138.40
| Facility | | $1,672.00 | $4,983.00 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.85 / $1,129.13 / $6,106.48
| Professional | | $724.85 | $1,129.13 | $6,106.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.82 / $692.82 / $2,160.52
| Professional | | $692.82 | $692.82 | $2,160.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.51 / $2,082.51 / $2,082.51
| Facility | | $2,082.51 | $2,082.51 | $2,082.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.55 / $1,457.88 / $2,428.28
| Professional | | $735.55 | $1,457.88 | $2,428.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.96 / $1,853.48 / $6,679.00
| Facility | | $846.96 | $1,853.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.89 / $1,181.58 / $1,631.06
| Professional | | $935.89 | $1,181.58 | $1,631.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,031.78 / $2,078.00 / $5,944.58
| Professional | | $1,031.78 | $2,078.00 | $5,944.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,572.00 / $26,542.00
| Facility | | $2,155.00 | $5,572.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.57 / $1,129.13 / $6,106.48
| Professional | | $774.57 | $1,129.13 | $6,106.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,402.00 / $8,810.00
| Facility | | $2,155.00 | $4,402.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.17 / $1,012.84 / $2,444.48
| Professional | | $766.17 | $1,012.84 | $2,444.48 |