- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.50 / $1,642.00 / $3,469.00
| Facility | | $371.50 | $1,642.00 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.56 / $340.63 / $790.10
| Professional | | $218.56 | $340.63 | $790.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.36 / $2,854.00 / $9,039.00
| Facility | | $657.36 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.34 / $504.60 / $1,959.44
| Professional | | $251.34 | $504.60 | $1,959.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.60 / $412.88 / $728.57
| Facility | | $317.60 | $412.88 | $728.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.04 / $626.35 / $855.46
| Professional | | $448.04 | $626.35 | $855.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.69 / $491.98 / $1,011.02
| Professional | | $299.69 | $491.98 | $1,011.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.45 / $579.10 / $6,679.00
| Facility | | $274.45 | $579.10 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.84 / $457.05 / $630.91
| Professional | | $364.84 | $457.05 | $630.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.64 / $689.59 / $1,015.04
| Professional | | $334.64 | $689.59 | $1,015.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,788.20 / $4,206.72 / $11,076.38
| Facility | | $2,788.20 | $4,206.72 | $11,076.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.81 / $508.07 / $520.94
| Professional | | $483.81 | $508.07 | $520.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,855.32 / $3,764.00 / $16,394.00
| Facility | | $1,855.32 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.02 / $628.22 / $2,384.16
| Professional | | $358.02 | $628.22 | $2,384.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.37 / $463.10 / $971.52
| Professional | | $295.37 | $463.10 | $971.52 |