- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,019.95 / $5,128.61
| Facility | | $676.08 | $3,019.95 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $524.81 / $1,584.89
| Professional | | $316.23 | $524.81 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,235.94 / $45,708.82
| Facility | | $851.14 | $3,235.94 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $562.34 / $2,570.40
| Professional | | $309.03 | $562.34 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $724.44 / $977.24
| Professional | | $436.52 | $724.44 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $562.34 / $1,000.00
| Professional | | $354.81 | $562.34 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $758.58 / $7,079.46
| Facility | | $346.74 | $758.58 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $489.78 / $660.69
| Professional | | $389.05 | $489.78 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $660.69 / $1,023.29
| Professional | | $346.74 | $660.69 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,388.44 / $4,466.84
| Facility | | $812.83 | $3,388.44 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $371.54 / $549.54
| Professional | | $309.03 | $371.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,235.94 / $45,708.82
| Facility | | $851.14 | $3,235.94 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $562.34 / $2,570.40
| Professional | | $309.03 | $562.34 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,981.07 / $9,120.11
| Facility | | $1,862.09 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $562.34 / $1,071.52
| Professional | | $354.81 | $562.34 | $1,071.52 |