- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.97 / $2,079.00 / $3,685.00
| Facility | | $605.97 | $2,079.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.21 / $412.75 / $1,374.75
| Professional | | $118.21 | $412.75 | $1,374.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.66 / $941.10 / $2,796.00
| Facility | | $166.66 | $941.10 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.85 / $1,247.09 / $4,041.53
| Professional | | $159.85 | $1,247.09 | $4,041.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.65 / $223.15 / $437.71
| Facility | | $171.65 | $223.15 | $437.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.46 / $949.25 / $1,740.35
| Professional | | $242.46 | $949.25 | $1,740.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.26 / $1,047.17 / $2,298.44
| Professional | | $236.26 | $1,047.17 | $2,298.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.22 / $234.74 / $6,679.00
| Facility | | $151.22 | $234.74 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $956.30 / $1,126.14 / $2,013.47
| Professional | | $956.30 | $1,126.14 | $2,013.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.60 / $789.39 / $2,076.71
| Professional | | $187.60 | $789.39 | $2,076.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.81 / $1,070.81 / $1,973.28
| Facility | | $1,070.81 | $1,070.81 | $1,973.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.02 / $226.02 / $244.47
| Professional | | $226.02 | $226.02 | $244.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,411.45 / $3,445.00
| Facility | | $55.00 | $1,411.45 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.25 / $2,161.01 / $6,656.40
| Professional | | $1,039.25 | $2,161.01 | $6,656.40 |
- 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
- $467.24 / $1,514.40 / $2,426.63
| Professional | | $467.24 | $1,514.40 | $2,426.63 |