- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.10 / $1,886.00 / $3,625.00
| Facility | | $379.10 | $1,886.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.76 / $342.18 / $588.27
| Professional | | $172.76 | $342.18 | $588.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.03 / $2,376.00 / $8,498.00
| Facility | | $448.03 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.07 / $660.80 / $3,347.52
| Professional | | $219.07 | $660.80 | $3,347.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.39 / $288.33 / $572.19
| Facility | | $224.39 | $288.33 | $572.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.50 / $579.42 / $1,062.33
| Professional | | $304.50 | $579.42 | $1,062.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.07 / $517.80 / $1,194.98
| Professional | | $243.07 | $517.80 | $1,194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.91 / $409.16 / $6,679.00
| Facility | | $191.91 | $409.16 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.13 / $665.08 / $929.74
| Professional | | $545.13 | $665.08 | $929.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.92 / $575.08 / $1,368.06
| Professional | | $255.92 | $575.08 | $1,368.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,441.50 / $3,441.50 / $3,441.50
| Facility | | $3,441.50 | $3,441.50 | $3,441.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.01 / $594.08 / $767.73
| Professional | | $295.01 | $594.08 | $767.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $957.17 / $3,372.00 / $12,000.00
| Facility | | $957.17 | $3,372.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.35 / $923.83 / $3,347.52
| Professional | | $483.35 | $923.83 | $3,347.52 |
- 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
- $476.09 / $706.89 / $1,343.95
| Professional | | $476.09 | $706.89 | $1,343.95 |