- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.68 / $2,079.00 / $3,685.00
| Facility | | $489.68 | $2,079.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.66 / $510.01 / $1,351.80
| Professional | | $371.66 | $510.01 | $1,351.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,878.00 / $3,804.00
| Facility | | $540.00 | $1,878.00 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.27 / $902.19 / $2,919.92
| Professional | | $447.27 | $902.19 | $2,919.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $479.38 / $616.00 / $1,099.70
| Facility | | $479.38 | $616.00 | $1,099.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.14 / $1,054.19 / $1,189.82
| Professional | | $786.14 | $1,054.19 | $1,189.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.41 / $831.90 / $1,521.69
| Professional | | $511.41 | $831.90 | $1,521.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $611.87 / $6,679.00
| Facility | | $214.32 | $611.87 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.05 / $747.29 / $1,031.55
| Professional | | $615.05 | $747.29 | $1,031.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.46 / $1,090.45 / $1,534.63
| Professional | | $513.46 | $1,090.45 | $1,534.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,941.55 / $2,941.55 / $2,941.55
| Facility | | $2,941.55 | $2,941.55 | $2,941.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.76 / $653.89 / $1,285.05
| Professional | | $289.76 | $653.89 | $1,285.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,078.00 / $7,161.00
| Facility | | $55.00 | $2,078.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.41 / $1,043.48 / $3,838.48
| Professional | | $580.41 | $1,043.48 | $3,838.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.65 / $820.55 / $1,606.56
| Professional | | $551.65 | $820.55 | $1,606.56 |