- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.79 / $2,663.12 / $4,410.00
| Facility | | $361.79 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.96 / $361.79 / $614.21
| Professional | | $254.96 | $361.79 | $614.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.46 / $1,153.03 / $4,142.00
| Facility | | $679.46 | $1,153.03 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.56 / $761.93 / $2,506.23
| Professional | | $376.56 | $761.93 | $2,506.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.40 / $527.02 / $929.99
| Facility | | $405.40 | $527.02 | $929.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.59 / $655.62 / $1,335.21
| Professional | | $387.59 | $655.62 | $1,335.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $554.40 / $8,090.00
| Facility | | $300.00 | $554.40 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.11 / $706.22 / $974.86
| Professional | | $561.11 | $706.22 | $974.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.90 / $886.23 / $1,381.30
| Professional | | $430.90 | $886.23 | $1,381.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $26,542.00
| Facility | | $627.00 | $1,818.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.70 / $911.70 / $3,641.92
| Professional | | $528.70 | $911.70 | $3,641.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.58 / $704.10 / $1,510.00
| Professional | | $458.58 | $704.10 | $1,510.00 |