- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.95 / $2,671.00 / $4,410.00
| Facility | | $462.95 | $2,671.00 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.79 / $418.08 / $742.07
| Professional | | $229.79 | $418.08 | $742.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.69 / $2,854.00 / $9,039.00
| Facility | | $584.69 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.33 / $700.06 / $3,333.44
| Professional | | $288.33 | $700.06 | $3,333.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.61 / $378.57 / $731.77
| Facility | | $294.61 | $378.57 | $731.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.14 / $680.71 / $1,132.25
| Professional | | $416.14 | $680.71 | $1,132.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.55 / $609.01 / $1,189.57
| Professional | | $314.55 | $609.01 | $1,189.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.83 / $537.17 / $6,679.00
| Facility | | $253.83 | $537.17 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.38 / $656.85 / $910.22
| Professional | | $538.38 | $656.85 | $910.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.14 / $685.90 / $1,331.78
| Professional | | $325.14 | $685.90 | $1,331.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,034.51 / $5,034.51 / $9,256.00
| Facility | | $5,034.51 | $5,034.51 | $9,256.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.29 / $748.09 / $825.84
| Professional | | $400.29 | $748.09 | $825.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,253.91 / $3,764.00 / $26,542.00
| Facility | | $1,253.91 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.30 / $998.34 / $3,333.44
| Professional | | $540.30 | $998.34 | $3,333.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $4,249.00 / $9,821.00
| Facility | | $1,700.00 | $4,249.00 | $9,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.35 / $737.87 / $1,406.94
| Professional | | $510.35 | $737.87 | $1,406.94 |