- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.55 / $2,122.00 / $4,355.00
| Facility | | $395.55 | $2,122.00 | $4,355.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.23 / $369.14 / $755.79
| Professional | | $215.23 | $369.14 | $755.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,052.09 / $3,445.00
| Facility | | $627.00 | $1,052.09 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.08 / $622.29 / $2,017.60
| Professional | | $302.08 | $622.29 | $2,017.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.83 / $422.29 / $745.18
| Facility | | $324.83 | $422.29 | $745.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.50 / $686.89 / $1,101.30
| Professional | | $414.50 | $686.89 | $1,101.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.26 / $651.09 / $1,309.08
| Professional | | $349.26 | $651.09 | $1,309.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.19 / $592.29 / $6,679.00
| Facility | | $281.19 | $592.29 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.55 / $588.39 / $812.20
| Professional | | $466.55 | $588.39 | $812.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.02 / $724.06 / $1,144.98
| Professional | | $342.02 | $724.06 | $1,144.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.92 / $227.92 / $4,267.18
| Facility | | $227.92 | $227.92 | $4,267.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.75 / $326.64 / $332.48
| Professional | | $315.75 | $326.64 | $332.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,902.36 / $26,542.00
| Facility | | $627.00 | $1,902.36 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.55 / $794.22 / $5,940.86
| Professional | | $460.55 | $794.22 | $5,940.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $3,445.00
| Facility | | $627.00 | $1,818.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.55 / $592.19 / $1,098.94
| Professional | | $363.55 | $592.19 | $1,098.94 |