- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.57 / $2,079.00 / $3,625.00
| Facility | | $157.57 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.72 / $173.92 / $354.58
| Professional | | $103.72 | $173.92 | $354.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.89 / $679.46 / $2,713.00
| Facility | | $290.89 | $679.46 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.41 / $300.11 / $961.20
| Professional | | $143.41 | $300.11 | $961.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.97 / $201.47 / $355.52
| Facility | | $154.97 | $201.47 | $355.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.94 / $320.26 / $522.04
| Professional | | $201.94 | $320.26 | $522.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Facility | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.58 / $269.92 / $558.24
| Professional | | $150.58 | $269.92 | $558.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.90 / $300.00 / $6,679.00
| Facility | | $133.90 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.14 / $292.20 / $403.36
| Professional | | $231.14 | $292.20 | $403.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.19 / $340.34 / $566.53
| Professional | | $162.19 | $340.34 | $566.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $966.90 / $3,445.00
| Facility | | $55.00 | $966.90 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.16 / $387.24 / $1,502.80
| Professional | | $205.16 | $387.24 | $1,502.80 |
- 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
- $194.91 / $286.33 / $662.20
| Professional | | $194.91 | $286.33 | $662.20 |