- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.29 / $2,240.00 / $7,629.00
| Facility | | $675.29 | $2,240.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.28 / $721.17 / $1,191.76
| Professional | | $588.28 | $721.17 | $1,191.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.38 / $742.38 / $1,300.34
| Professional | | $715.38 | $742.38 | $1,300.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.00 / $358.00 / $358.00
| Facility | | $358.00 | $358.00 | $358.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.18 / $711.19 / $1,154.26
| Professional | | $511.18 | $711.19 | $1,154.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $869.38 / $869.38 / $1,121.08
| Professional | | $869.38 | $869.38 | $1,121.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.41 / $585.41 / $585.41
| Professional | | $585.41 | $585.41 | $585.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $2,371.00 / $8,017.00
| Facility | | $657.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.33 / $754.17 / $1,767.77
| Professional | | $602.33 | $754.17 | $1,767.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.70 / $901.70 / $901.70
| Professional | | $901.70 | $901.70 | $901.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.00 / $358.00 / $358.00
| Facility | | $358.00 | $358.00 | $358.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.61 / $730.10 / $1,154.26
| Professional | | $527.61 | $730.10 | $1,154.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.15 / $604.95 / $891.47
| Facility | | $529.15 | $604.95 | $891.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.89 / $699.91 / $891.47
| Professional | | $592.89 | $699.91 | $891.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.00 / $2,949.00 / $6,000.00
| Facility | | $1,122.00 | $2,949.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.90 / $824.28 / $1,432.77
| Professional | | $603.90 | $824.28 | $1,432.77 |