- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.68 / $2,663.12 / $3,625.00
| Facility | | $388.68 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.98 / $441.37 / $915.51
| Professional | | $257.98 | $441.37 | $915.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.35 / $2,854.00 / $9,039.00
| Facility | | $830.35 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.75 / $795.65 / $2,545.19
| Professional | | $388.75 | $795.65 | $2,545.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.21 / $542.37 / $957.08
| Facility | | $417.21 | $542.37 | $957.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.15 / $866.42 / $1,306.59
| Professional | | $566.15 | $866.42 | $1,306.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.40 / $782.52 / $1,591.50
| Professional | | $435.40 | $782.52 | $1,591.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.03 / $760.74 / $6,679.00
| Facility | | $352.03 | $760.74 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.99 / $760.93 / $1,050.39
| Professional | | $600.99 | $760.93 | $1,050.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.86 / $926.95 / $1,602.39
| Professional | | $437.86 | $926.95 | $1,602.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.32 / $2,290.32 / $2,290.32
| Facility | | $2,290.32 | $2,290.32 | $2,290.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,067.51 / $1,067.51 / $1,067.51
| Professional | | $1,067.51 | $1,067.51 | $1,067.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.69 / $3,764.00 / $16,394.00
| Facility | | $1,775.69 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.23 / $993.66 / $3,878.88
| Professional | | $544.23 | $993.66 | $3,878.88 |
- 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
- $443.77 / $736.63 / $1,490.50
| Professional | | $443.77 | $736.63 | $1,490.50 |