- 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
- $710.77 / $802.92 / $1,242.34
| Professional | | $710.77 | $802.92 | $1,242.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.56 / $3,895.00 / $13,483.66
| Facility | | $891.56 | $3,895.00 | $13,483.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.27 / $1,325.14 / $5,736.72
| Professional | | $783.27 | $1,325.14 | $5,736.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,043.00 / $1,546.49 / $2,094.96
| Professional | | $1,043.00 | $1,546.49 | $2,094.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.88 / $1,328.88 / $2,271.81
| Professional | | $802.88 | $1,328.88 | $2,271.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,289.64 / $8,090.00
| Facility | | $300.00 | $1,289.64 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.53 / $1,105.36 / $1,513.18
| Professional | | $912.53 | $1,105.36 | $1,513.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.41 / $1,963.39 / $2,590.02
| Professional | | $990.41 | $1,963.39 | $2,590.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,751.20 / $13,773.00
| Facility | | $55.00 | $4,751.20 | $13,773.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.18 / $1,458.92 / $5,736.72
| Professional | | $846.18 | $1,458.92 | $5,736.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.27 / $1,193.33 / $2,466.71
| Professional | | $783.27 | $1,193.33 | $2,466.71 |