- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.91 / $2,618.00 / $4,410.00
| Facility | | $386.91 | $2,618.00 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.31 / $509.93 / $1,001.90
| Professional | | $272.31 | $509.93 | $1,001.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.00 / $1,078.00 / $3,445.00
| Facility | | $736.00 | $1,078.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.45 / $745.29 / $2,550.00
| Professional | | $363.45 | $745.29 | $2,550.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.72 / $506.64 / $894.02
| Facility | | $389.72 | $506.64 | $894.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.85 / $803.17 / $1,229.14
| Professional | | $528.85 | $803.17 | $1,229.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.94 / $794.11 / $1,560.22
| Professional | | $457.94 | $794.11 | $1,560.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.14 / $710.60 / $6,679.00
| Facility | | $331.14 | $710.60 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.41 / $687.99 / $949.70
| Professional | | $546.41 | $687.99 | $949.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.83 / $869.73 / $1,337.49
| Professional | | $410.83 | $869.73 | $1,337.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.16 / $600.16 / $600.16
| Facility | | $600.16 | $600.16 | $600.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.16 / $390.38 / $800.58
| Professional | | $361.16 | $390.38 | $800.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,286.78 / $26,542.00
| Facility | | $627.00 | $2,286.78 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.66 / $927.92 / $3,564.16
| Professional | | $554.66 | $927.92 | $3,564.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.67 / $699.98 / $1,342.75
| Professional | | $473.67 | $699.98 | $1,342.75 |