- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.95 / $2,618.00 / $3,625.00
| Facility | | $391.95 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.02 / $391.95 / $679.14
| Professional | | $280.02 | $391.95 | $679.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.02 / $2,376.00 / $8,498.00
| Facility | | $729.02 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.91 / $700.18 / $3,006.32
| Professional | | $328.91 | $700.18 | $3,006.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.76 / $472.57 / $843.64
| Facility | | $367.76 | $472.57 | $843.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.04 / $834.95 / $912.78
| Professional | | $603.04 | $834.95 | $912.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.60 / $623.01 / $1,168.09
| Professional | | $361.60 | $623.01 | $1,168.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.49 / $670.56 / $6,679.00
| Facility | | $307.49 | $670.56 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.98 / $590.48 / $817.01
| Professional | | $483.98 | $590.48 | $817.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.51 / $824.17 / $1,204.79
| Professional | | $387.51 | $824.17 | $1,204.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,867.80 / $2,867.80 / $2,867.80
| Facility | | $2,867.80 | $2,867.80 | $2,867.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.00 / $444.00 / $478.94
| Professional | | $444.00 | $444.00 | $478.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $16,394.00
| Facility | | $1,640.00 | $3,372.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.15 / $871.68 / $3,006.32
| Professional | | $429.15 | $871.68 | $3,006.32 |
- 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
- $417.79 / $647.87 / $1,272.29
| Professional | | $417.79 | $647.87 | $1,272.29 |