- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $401.04 / $2,067.00 / $3,625.00
| Facility | | $401.04 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.92 / $407.65 / $638.92
| Professional | | $357.92 | $407.65 | $638.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $684.72 / $1,856.00 / $4,142.00
| Facility | | $684.72 | $1,856.00 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.10 / $824.29 / $3,238.00
| Professional | | $402.10 | $824.29 | $3,238.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.96 / $632.16 / $1,128.56
| Facility | | $491.96 | $632.16 | $1,128.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.95 / $711.85 / $1,242.30
| Professional | | $427.95 | $711.85 | $1,242.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.50 / $897.04 / $6,679.00
| Facility | | $411.50 | $897.04 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.85 / $631.60 / $871.85
| Professional | | $519.85 | $631.60 | $871.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.31 / $1,028.91 / $1,380.36
| Professional | | $508.31 | $1,028.91 | $1,380.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,098.46 / $12,000.00
| Facility | | $627.00 | $2,098.46 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.13 / $884.25 / $3,238.00
| Professional | | $469.13 | $884.25 | $3,238.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.92 / $727.34 / $1,378.11
| Professional | | $458.92 | $727.34 | $1,378.11 |