- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.63 / $2,079.00 / $3,625.00
| Facility | | $161.63 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.68 / $192.83 / $324.41
| Professional | | $137.68 | $192.83 | $324.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $713.54 / $2,713.00
| Facility | | $308.00 | $713.54 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.92 / $426.36 / $1,774.80
| Professional | | $197.92 | $426.36 | $1,774.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.52 / $324.49 / $579.28
| Facility | | $252.52 | $324.49 | $579.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Facility | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.53 / $367.83 / $662.77
| Professional | | $216.53 | $367.83 | $662.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.42 / $345.33 / $8,090.00
| Facility | | $209.42 | $345.33 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.58 / $350.85 / $486.96
| Professional | | $287.58 | $350.85 | $486.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.07 / $535.94 / $682.63
| Professional | | $260.07 | $535.94 | $682.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.79 / $281.79 / $281.79
| Professional | | $281.79 | $281.79 | $281.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,079.72 / $3,445.00
| Facility | | $55.00 | $1,079.72 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.63 / $458.75 / $1,774.80
| Professional | | $219.63 | $458.75 | $1,774.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.34 / $376.11 / $743.19
| Professional | | $218.34 | $376.11 | $743.19 |