- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.37 / $2,663.12 / $3,693.00
| Facility | | $270.37 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.37 / $381.41 / $585.28
| Professional | | $270.37 | $381.41 | $585.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.67 / $2,123.69 / $7,250.00
| Facility | | $284.67 | $2,123.69 | $7,250.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.29 / $787.60 / $3,388.88
| Professional | | $346.29 | $787.60 | $3,388.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.19 / $480.83 / $857.64
| Facility | | $374.19 | $480.83 | $857.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.25 / $814.13 / $1,206.59
| Professional | | $576.25 | $814.13 | $1,206.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.04 / $680.00 / $766.82
| Facility | | $609.04 | $680.00 | $766.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.13 / $640.80 / $1,242.41
| Professional | | $326.13 | $640.80 | $1,242.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $511.73 / $6,679.00
| Facility | | $300.00 | $511.73 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.29 / $715.11 / $1,019.59
| Professional | | $549.29 | $715.11 | $1,019.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.43 / $844.64 / $1,289.22
| Professional | | $451.43 | $844.64 | $1,289.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,324.00 / $9,849.00
| Facility | | $55.00 | $2,324.00 | $9,849.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.40 / $1,099.09 / $3,388.88
| Professional | | $418.40 | $1,099.09 | $3,388.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,006.00 / $10,764.00
| Facility | | $1,591.00 | $4,006.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.68 / $654.80 / $1,558.14
| Professional | | $374.68 | $654.80 | $1,558.14 |