- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.85 / $2,410.00 / $3,693.00
| Facility | | $267.85 | $2,410.00 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.17 / $267.85 / $595.60
| Professional | | $112.17 | $267.85 | $595.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.89 / $2,948.45 / $10,821.00
| Facility | | $310.89 | $2,948.45 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.59 / $434.64 / $1,978.72
| Professional | | $164.59 | $434.64 | $1,978.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.84 / $192.19 / $376.99
| Facility | | $147.84 | $192.19 | $376.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.82 / $393.58 / $718.98
| Professional | | $208.82 | $393.58 | $718.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.64 / $421.11 / $854.94
| Professional | | $201.64 | $421.11 | $854.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $300.00 / $6,679.00
| Facility | | $130.00 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.58 / $398.78 / $712.99
| Professional | | $315.58 | $398.78 | $712.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.88 / $352.01 / $743.84
| Professional | | $162.88 | $352.01 | $743.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.06 / $1,640.09 / $11,839.53
| Facility | | $178.06 | $1,640.09 | $11,839.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.52 / $202.06 / $291.13
| Professional | | $137.52 | $202.06 | $291.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,035.85 / $3,649.00 / $16,394.00
| Facility | | $1,035.85 | $3,649.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.01 / $715.85 / $1,978.72
| Professional | | $358.01 | $715.85 | $1,978.72 |
- 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
- $335.05 / $528.57 / $961.39
| Professional | | $335.05 | $528.57 | $961.39 |