- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.36 / $2,663.12 / $3,625.00
| Facility | | $514.36 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.39 / $514.36 / $836.89
| Professional | | $351.39 | $514.36 | $836.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.72 / $2,854.00 / $9,039.00
| Facility | | $836.72 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.51 / $707.66 / $2,548.32
| Professional | | $390.51 | $707.66 | $2,548.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $415.16 / $539.71 / $952.38
| Facility | | $415.16 | $539.71 | $952.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $605.88 / $1,316.29
| Professional | | $605.88 | $605.88 | $1,316.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.32 / $1,346.32 / $1,346.32
| Facility | | $1,346.32 | $1,346.32 | $1,346.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.45 / $752.33 / $1,403.57
| Professional | | $394.45 | $752.33 | $1,403.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $349.49 / $757.00 / $6,679.00
| Facility | | $349.49 | $757.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.46 / $732.87 / $1,011.65
| Professional | | $578.46 | $732.87 | $1,011.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.85 / $934.89 / $1,664.56
| Professional | | $428.85 | $934.89 | $1,664.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,764.00 / $16,394.00
| Facility | | $1,685.00 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.48 / $824.90 / $3,757.92
| Professional | | $513.48 | $824.90 | $3,757.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.17 / $688.12 / $1,526.68
| Professional | | $498.17 | $688.12 | $1,526.68 |