- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.97 / $860.00 / $3,740.00
| Facility | | $224.97 | $860.00 | $3,740.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.97 / $509.93 / $726.35
| Professional | | $224.97 | $509.93 | $726.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.21 / $659.28 / $9,271.00
| Facility | | $343.21 | $659.28 | $9,271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.04 / $419.00 / $540.60
| Professional | | $328.04 | $419.00 | $540.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.85 / $13,236.13 / $47,249.53
| Facility | | $914.85 | $13,236.13 | $47,249.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.36 / $11,664.34 / $20,438.15
| Professional | | $908.36 | $11,664.34 | $20,438.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.20 / $847.20 / $847.20
| Facility | | $847.20 | $847.20 | $847.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,526.70 / $3,526.70 / $3,526.70
| Professional | | $3,526.70 | $3,526.70 | $3,526.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $3,000.00
| Professional | | $45.00 | $45.00 | $3,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $4,298.00 / $30,001.00
| Facility | | $599.00 | $4,298.00 | $30,001.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.69 / $768.16 / $1,139.55
| Professional | | $487.69 | $768.16 | $1,139.55 |