- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,801.89 / $7,244.36
| Facility | | $741.31 | $3,801.89 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $645.65 / $3,019.95
| Professional | | $158.49 | $645.65 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $245.47 / $251.19
| Professional | | $223.87 | $245.47 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,466.84 / $57,543.99
| Facility | | $3,801.89 | $4,466.84 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,230.27 / $1,819.70
| Professional | | $630.96 | $1,230.27 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $691.83 / $1,621.81
| Professional | | $194.98 | $691.83 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,122.02 / $1,230.27
| Professional | | $870.96 | $1,122.02 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $1,000.00 / $1,479.11
| Professional | | $223.87 | $1,000.00 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,981.07 / $7,762.47
| Facility | | $2,041.74 | $3,981.07 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,630.78 / $7,244.36
| Facility | | $741.31 | $3,630.78 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $691.83 / $2,238.72
| Professional | | $165.96 | $691.83 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,698.24
| Facility | | $1,202.26 | $1,202.26 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,380.38 / $2,187.76
| Professional | | $1,096.48 | $1,380.38 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $354.81 / $1,047.13
| Facility | | $173.78 | $354.81 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $354.81 / $758.58
| Professional | | $173.78 | $354.81 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,691.53 / $5,888.44
| Facility | | $1,000.00 | $2,691.53 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $501.19 / $1,445.44
| Professional | | $169.82 | $501.19 | $1,445.44 |