- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.17 / $2,240.00 / $8,017.00
| Facility | | $273.17 | $2,240.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.91 / $233.06 / $313.77
| Professional | | $143.91 | $233.06 | $313.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,772.00 / $2,838.15 / $8,459.92
| Facility | | $1,772.00 | $2,838.15 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.09 / $257.45 / $257.45
| Professional | | $248.09 | $257.45 | $257.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.50 / $261.50 / $261.50
| Facility | | $261.50 | $261.50 | $261.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.19 / $256.60 / $457.42
| Professional | | $153.19 | $256.60 | $457.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.12 / $399.65 / $514.94
| Professional | | $298.12 | $399.65 | $514.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.93 / $1,689.93 / $9,695.04
| Facility | | $1,689.93 | $1,689.93 | $9,695.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.00 / $2,371.00 / $8,017.00
| Facility | | $536.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.28 / $248.68 / $829.72
| Professional | | $146.28 | $248.68 | $829.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.10 / $185.10 / $566.29
| Professional | | $185.10 | $185.10 | $566.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.50 / $261.50 / $261.50
| Facility | | $261.50 | $261.50 | $261.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.55 / $257.88 / $467.35
| Professional | | $157.55 | $257.88 | $467.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.26 / $150.90 / $248.60
| Facility | | $129.26 | $150.90 | $248.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.99 / $198.89 / $267.48
| Professional | | $146.99 | $198.89 | $267.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.00 / $1,219.00 / $3,742.00
| Facility | | $435.00 | $1,219.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.68 / $306.52 / $486.84
| Professional | | $214.68 | $306.52 | $486.84 |