- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.40 / $2,747.00 / $4,806.64
| Facility | | $188.40 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.40 / $386.59 / $673.87
| Professional | | $188.40 | $386.59 | $673.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.98 / $2,329.00 / $4,755.00
| Facility | | $338.98 | $2,329.00 | $4,755.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.74 / $682.85 / $4,557.05
| Professional | | $230.74 | $682.85 | $4,557.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.25 / $311.29 / $617.74
| Facility | | $242.25 | $311.29 | $617.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.00 / $577.66 / $1,384.53
| Professional | | $264.00 | $577.66 | $1,384.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.73 / $441.72 / $6,679.00
| Facility | | $209.73 | $441.72 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.19 / $782.28 / $1,089.92
| Professional | | $641.19 | $782.28 | $1,089.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.20 / $680.76 / $1,635.87
| Professional | | $285.20 | $680.76 | $1,635.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,338.00 / $8,498.00
| Facility | | $55.00 | $2,338.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.50 / $1,074.92 / $4,557.05
| Professional | | $446.50 | $1,074.92 | $4,557.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.96 / $748.84 / $1,589.50
| Professional | | $385.96 | $748.84 | $1,589.50 |