- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.27 / $481.49 / $5,320.00
| Facility | | $301.27 | $481.49 | $5,320.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.87 / $389.41 / $500.05
| Professional | | $320.87 | $389.41 | $500.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $2,316.00 / $4,229.00
| Facility | | $1,258.00 | $2,316.00 | $4,229.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.50 / $323.82 / $501.70
| Professional | | $242.50 | $323.82 | $501.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.37 / $467.42 / $539.20
| Facility | | $331.37 | $467.42 | $539.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.36 / $468.25 / $751.21
| Professional | | $326.36 | $468.25 | $751.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.19 / $614.32 / $614.32
| Facility | | $175.19 | $614.32 | $614.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.88 / $577.04 / $943.59
| Professional | | $335.88 | $577.04 | $943.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $79.42 / $459.61
| Professional | | $32.34 | $79.42 | $459.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $2,723.00 / $6,295.00
| Facility | | $599.00 | $2,723.00 | $6,295.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.50 / $593.21 / $945.80
| Professional | | $418.50 | $593.21 | $945.80 |