- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $415.80 / $2,663.12 / $4,712.00
| Facility | | $415.80 | $2,663.12 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.45 / $404.08 / $646.54
| Professional | | $263.45 | $404.08 | $646.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.93 / $2,854.00 / $9,039.00
| Facility | | $661.93 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.48 / $695.12 / $3,019.12
| Professional | | $320.48 | $695.12 | $3,019.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.22 / $430.76 / $768.99
| Facility | | $335.22 | $430.76 | $768.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.92 / $655.38 / $922.16
| Professional | | $459.92 | $655.38 | $922.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.07 / $598.95 / $1,136.92
| Professional | | $357.07 | $598.95 | $1,136.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.39 / $611.24 / $6,679.00
| Facility | | $289.39 | $611.24 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.14 / $584.66 / $807.07
| Professional | | $481.14 | $584.66 | $807.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.72 / $772.10 / $1,200.03
| Professional | | $367.72 | $772.10 | $1,200.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.45 / $3,764.00 / $26,542.00
| Facility | | $1,436.45 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.45 / $894.58 / $3,019.12
| Professional | | $464.45 | $894.58 | $3,019.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.15 / $683.12 / $1,257.13
| Professional | | $432.15 | $683.12 | $1,257.13 |