- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.79 / $2,067.00 / $3,625.00
| Facility | | $332.79 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.03 / $332.79 / $689.65
| Professional | | $243.03 | $332.79 | $689.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.90 / $1,822.20 / $3,804.00
| Facility | | $441.90 | $1,822.20 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.60 / $601.54 / $1,913.92
| Professional | | $294.60 | $601.54 | $1,913.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.45 / $409.22 / $730.55
| Facility | | $318.45 | $409.22 | $730.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.24 / $750.63 / $790.42
| Professional | | $522.24 | $750.63 | $790.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.22 / $555.29 / $1,004.24
| Professional | | $330.22 | $555.29 | $1,004.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $406.48 / $6,679.00
| Facility | | $214.32 | $406.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.91 / $530.61 / $734.52
| Professional | | $434.91 | $530.61 | $734.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.92 / $721.98 / $1,078.79
| Professional | | $344.92 | $721.98 | $1,078.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.00 / $3,025.53 / $4,436.96
| Facility | | $972.00 | $3,025.53 | $4,436.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.00 / $684.00 / $761.39
| Professional | | $383.00 | $684.00 | $761.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,822.20 / $7,161.00
| Facility | | $55.00 | $1,822.20 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.52 / $714.15 / $2,696.48
| Professional | | $387.52 | $714.15 | $2,696.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.53 / $541.97 / $1,158.52
| Professional | | $373.53 | $541.97 | $1,158.52 |