- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.00 / $1,985.76 / $5,458.70
| Facility | | $570.00 | $1,985.76 | $5,458.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.20 / $630.79 / $646.00
| Professional | | $414.20 | $630.79 | $646.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.00 / $1,427.81 / $3,784.04
| Facility | | $614.00 | $1,427.81 | $3,784.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.00 / $361.76 / $682.48
| Professional | | $304.00 | $361.76 | $682.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.30 / $549.48 / $6,817.20
| Facility | | $59.30 | $549.48 | $6,817.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.80 / $494.00 / $1,241.86
| Professional | | $345.80 | $494.00 | $1,241.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.60 / $1,274.52 / $2,544.10
| Facility | | $516.60 | $1,274.52 | $2,544.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.00 / $912.00 / $1,216.00
| Professional | | $760.00 | $912.00 | $1,216.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.00 / $874.00 / $1,656.80
| Professional | | $684.00 | $874.00 | $1,656.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.40 / $3,610.00 / $3,610.00
| Facility | | $1,322.40 | $3,610.00 | $3,610.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,800.00 / $3,800.00 / $5,700.00
| Professional | | $3,800.00 | $3,800.00 | $5,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.00 / $912.00 / $2,016.51
| Facility | | $608.00 | $912.00 | $2,016.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.00 / $836.00 / $1,140.00
| Professional | | $760.00 | $836.00 | $1,140.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.00 / $760.00 / $760.00
| Professional | | $760.00 | $760.00 | $760.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.20 / $322.24 / $1,830.00
| Professional | | $319.20 | $322.24 | $1,830.00 |