- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.25 / $2,618.00 / $3,625.00
| Facility | | $387.25 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.88 / $414.19 / $861.31
| Professional | | $294.88 | $414.19 | $861.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.96 / $3,372.00 / $10,821.00
| Facility | | $676.96 | $3,372.00 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.80 / $726.76 / $3,040.08
| Professional | | $308.80 | $726.76 | $3,040.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.51 / $421.86 / $744.43
| Facility | | $324.51 | $421.86 | $744.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.45 / $723.82 / $1,480.95
| Professional | | $422.45 | $723.82 | $1,480.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.33 / $591.70 / $6,679.00
| Facility | | $284.33 | $591.70 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.39 / $480.54 / $774.72
| Professional | | $260.39 | $480.54 | $774.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.28 / $769.29 / $1,144.88
| Professional | | $357.28 | $769.29 | $1,144.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.06 / $430.06 / $430.06
| Professional | | $430.06 | $430.06 | $430.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.82 / $3,649.00 / $16,394.00
| Facility | | $1,383.82 | $3,649.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.70 / $1,096.72 / $3,040.08
| Professional | | $498.70 | $1,096.72 | $3,040.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.27 / $670.71 / $1,534.26
| Professional | | $476.27 | $670.71 | $1,534.26 |