- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.82 / $2,663.12 / $4,712.00
| Facility | | $413.82 | $2,663.12 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.89 / $402.89 / $666.99
| Professional | | $252.89 | $402.89 | $666.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.08 / $2,826.85 / $9,039.00
| Facility | | $648.08 | $2,826.85 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.67 / $695.46 / $3,043.20
| Professional | | $324.67 | $695.46 | $3,043.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.64 / $423.59 / $756.19
| Facility | | $329.64 | $423.59 | $756.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.52 / $652.01 / $1,111.74
| Professional | | $429.52 | $652.01 | $1,111.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.06 / $581.86 / $1,107.71
| Professional | | $344.06 | $581.86 | $1,107.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.41 / $601.05 / $6,679.00
| Facility | | $283.41 | $601.05 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.99 / $593.97 / $819.91
| Professional | | $486.99 | $593.97 | $819.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.12 / $754.84 / $1,213.38
| Professional | | $359.12 | $754.84 | $1,213.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,784.74 / $4,784.74 / $4,784.74
| Facility | | $4,784.74 | $4,784.74 | $4,784.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.60 / $547.60 / $618.49
| Professional | | $547.60 | $547.60 | $618.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,413.36 / $3,764.00 / $26,542.00
| Facility | | $1,413.36 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.68 / $891.15 / $3,043.20
| Professional | | $462.68 | $891.15 | $3,043.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.61 / $672.53 / $1,223.57
| Professional | | $401.61 | $672.53 | $1,223.57 |