- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.18 / $3,396.18 / $7,275.00
| Facility | | $310.18 | $3,396.18 | $7,275.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.95 / $536.86 / $3,952.89
| Professional | | $288.95 | $536.86 | $3,952.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.00 / $3,693.00 / $4,290.00
| Facility | | $3,060.00 | $3,693.00 | $4,290.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.69 / $313.22 / $517.84
| Professional | | $248.69 | $313.22 | $517.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.08 / $298.30 / $599.58
| Professional | | $293.08 | $298.30 | $599.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.13 / $610.00 / $1,035.00
| Facility | | $454.13 | $610.00 | $1,035.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.05 / $628.94 / $4,744.54
| Professional | | $310.05 | $628.94 | $4,744.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,980.42 / $2,640.56 / $3,300.70
| Professional | | $1,980.42 | $2,640.56 | $3,300.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.32 / $748.57 / $4,633.46
| Facility | | $307.32 | $748.57 | $4,633.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,965.00 / $4,037.00 / $7,931.00
| Professional | | $2,965.00 | $4,037.00 | $7,931.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.19 / $402.87 / $649.97
| Facility | | $301.19 | $402.87 | $649.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $619.90 / $2,052.00 / $6,143.69
| Professional | | $619.90 | $2,052.00 | $6,143.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $2,500.00 / $5,226.00
| Facility | | $500.00 | $2,500.00 | $5,226.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.72 / $2,727.41 / $5,351.07
| Professional | | $548.72 | $2,727.41 | $5,351.07 |