- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.14 / $2,663.12 / $3,693.00
| Facility | | $444.14 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.06 / $428.96 / $865.03
| Professional | | $247.06 | $428.96 | $865.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.07 / $2,376.00 / $8,498.00
| Facility | | $786.07 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.27 / $810.99 / $3,670.48
| Professional | | $326.27 | $810.99 | $3,670.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.64 / $509.68 / $909.89
| Facility | | $396.64 | $509.68 | $909.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.41 / $984.46 / $1,547.33
| Professional | | $650.41 | $984.46 | $1,547.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.58 / $699.90 / $1,337.85
| Professional | | $325.58 | $699.90 | $1,337.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.35 / $723.24 / $6,679.00
| Facility | | $333.35 | $723.24 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.82 / $723.27 / $1,000.33
| Professional | | $592.82 | $723.27 | $1,000.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.82 / $914.27 / $1,486.43
| Professional | | $434.82 | $914.27 | $1,486.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,308.68 / $5,308.68 / $5,308.68
| Facility | | $5,308.68 | $5,308.68 | $5,308.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.68 / $472.68 / $472.68
| Professional | | $472.68 | $472.68 | $472.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $16,394.00
| Facility | | $1,640.00 | $3,372.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.66 / $1,033.24 / $3,670.48
| Professional | | $360.66 | $1,033.24 | $3,670.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.82 / $678.96 / $1,422.59
| Professional | | $328.82 | $678.96 | $1,422.59 |