- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.33 / $2,618.00 / $3,625.00
| Facility | | $396.33 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.45 / $368.40 / $666.52
| Professional | | $170.45 | $368.40 | $666.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.37 / $1,275.80 / $7,958.00
| Facility | | $391.37 | $1,275.80 | $7,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.07 / $624.16 / $2,918.96
| Professional | | $185.07 | $624.16 | $2,918.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.10 / $245.83 / $482.21
| Facility | | $189.10 | $245.83 | $482.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.87 / $555.00 / $1,276.13
| Professional | | $243.87 | $555.00 | $1,276.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.22 / $344.80 / $6,679.00
| Facility | | $165.22 | $344.80 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.56 / $442.08 / $672.99
| Professional | | $229.56 | $442.08 | $672.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.40 / $448.18 / $983.93
| Professional | | $207.40 | $448.18 | $983.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.31 / $2,430.00 / $16,394.00
| Facility | | $806.31 | $2,430.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.29 / $974.59 / $2,918.96
| Professional | | $499.29 | $974.59 | $2,918.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.63 / $636.84 / $1,443.07
| Professional | | $467.63 | $636.84 | $1,443.07 |