- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.10 / $1,845.24 / $3,625.00
| Facility | | $502.10 | $1,845.24 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.11 / $368.27 / $650.57
| Professional | | $308.11 | $368.27 | $650.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,783.39 / $4,142.00
| Facility | | $627.00 | $1,783.39 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.50 / $712.12 / $2,800.40
| Professional | | $361.50 | $712.12 | $2,800.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.93 / $537.04 / $958.73
| Facility | | $417.93 | $537.04 | $958.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.32 / $718.06 / $1,021.10
| Professional | | $469.32 | $718.06 | $1,021.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.28 / $614.86 / $1,072.83
| Professional | | $380.28 | $614.86 | $1,072.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $349.88 / $762.06 / $6,679.00
| Facility | | $349.88 | $762.06 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.14 / $545.54 / $753.07
| Professional | | $449.14 | $545.54 | $753.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.13 / $884.67 / $1,172.56
| Professional | | $432.13 | $884.67 | $1,172.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $849.31 / $849.31 / $849.31
| Facility | | $849.31 | $849.31 | $849.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.85 / $497.80 / $1,225.89
| Professional | | $434.85 | $497.80 | $1,225.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $16,394.00
| Facility | | $627.00 | $1,818.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.31 / $793.76 / $2,800.40
| Professional | | $410.31 | $793.76 | $2,800.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $3,445.00
| Facility | | $627.00 | $1,818.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.44 / $599.03 / $1,154.71
| Professional | | $398.44 | $599.03 | $1,154.71 |