- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.70 / $2,663.12 / $3,625.00
| Facility | | $530.70 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.51 / $530.70 / $858.71
| Professional | | $381.51 | $530.70 | $858.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.40 / $2,854.00 / $9,039.00
| Facility | | $906.40 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.55 / $742.57 / $2,757.52
| Professional | | $417.55 | $742.57 | $2,757.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.39 / $590.71 / $1,042.36
| Facility | | $454.39 | $590.71 | $1,042.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $878.25 / $1,316.29
| Professional | | $605.88 | $878.25 | $1,316.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.32 / $1,346.32 / $1,346.32
| Facility | | $1,346.32 | $1,346.32 | $1,346.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.30 / $805.98 / $1,452.40
| Professional | | $405.30 | $805.98 | $1,452.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.41 / $828.54 / $6,679.00
| Facility | | $380.41 | $828.54 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.52 / $750.71 / $1,038.49
| Professional | | $592.52 | $750.71 | $1,038.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.90 / $1,008.37 / $1,702.04
| Professional | | $464.90 | $1,008.37 | $1,702.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $997.27 / $997.27 / $997.27
| Facility | | $997.27 | $997.27 | $997.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,764.00 / $16,394.00
| Facility | | $1,685.00 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.49 / $845.02 / $3,840.72
| Professional | | $559.49 | $845.02 | $3,840.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.21 / $733.25 / $1,564.46
| Professional | | $517.21 | $733.25 | $1,564.46 |