- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.75 / $2,547.00 / $3,693.00
| Facility | | $522.75 | $2,547.00 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.20 / $476.57 / $848.61
| Professional | | $261.20 | $476.57 | $848.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.82 / $2,854.00 / $9,039.00
| Facility | | $398.82 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.40 / $635.50 / $3,173.36
| Professional | | $219.40 | $635.50 | $3,173.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.89 / $254.29 / $453.96
| Facility | | $197.89 | $254.29 | $453.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.44 / $430.55 / $618.17
| Professional | | $277.44 | $430.55 | $618.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.38 / $458.12 / $1,124.44
| Professional | | $243.38 | $458.12 | $1,124.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.68 / $360.84 / $6,679.00
| Facility | | $173.68 | $360.84 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.25 / $401.25 / $552.64
| Professional | | $331.25 | $401.25 | $552.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.64 / $470.24 / $835.35
| Professional | | $223.64 | $470.24 | $835.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,788.20 / $2,899.73 / $5,785.53
| Facility | | $2,788.20 | $2,899.73 | $5,785.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.06 / $270.91 / $1,004.98
| Professional | | $134.06 | $270.91 | $1,004.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $975.35 / $3,764.00 / $16,394.00
| Facility | | $975.35 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.93 / $940.27 / $3,173.36
| Professional | | $484.93 | $940.27 | $3,173.36 |
- 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
- $447.66 / $721.44 / $1,268.85
| Professional | | $447.66 | $721.44 | $1,268.85 |