- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.32 / $3,570.00 / $10,893.00
| Facility | | $734.32 | $3,570.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.22 / $693.24 / $1,023.33
| Professional | | $603.22 | $693.24 | $1,023.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.12 / $784.26 / $1,146.86
| Professional | | $570.12 | $784.26 | $1,146.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.08 / $645.08 / $660.27
| Facility | | $645.08 | $645.08 | $660.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.22 / $2,024.00 / $4,619.00
| Facility | | $759.22 | $2,024.00 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.96 / $850.66 / $1,288.65
| Professional | | $609.96 | $850.66 | $1,288.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $4,589.93
| Facility | | $55.00 | $55.00 | $4,589.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,789.28 / $4,878.32 / $5,827.20
| Professional | | $4,789.28 | $4,878.32 | $5,827.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.59 / $768.88 / $1,404.00
| Facility | | $626.59 | $768.88 | $1,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.22 / $1,010.09 / $1,188.33
| Professional | | $759.22 | $1,010.09 | $1,188.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $876.70 / $1,727.10
| Professional | | $5.00 | $876.70 | $1,727.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.71 / $781.13 / $1,486.67
| Facility | | $628.71 | $781.13 | $1,486.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.45 / $893.37 / $1,654.36
| Professional | | $631.45 | $893.37 | $1,654.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,970.00 / $8,583.00
| Facility | | $385.00 | $1,970.00 | $8,583.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.83 / $694.00 / $1,124.68
| Professional | | $513.83 | $694.00 | $1,124.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.45 / $655.42 / $885.67
| Professional | | $563.45 | $655.42 | $885.67 |