- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.80 / $2,079.00 / $3,625.00
| Facility | | $234.80 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.47 / $234.80 / $538.85
| Professional | | $153.47 | $234.80 | $538.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.91 / $2,871.43 / $10,821.00
| Facility | | $517.91 | $2,871.43 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.25 / $558.51 / $2,396.64
| Professional | | $236.25 | $558.51 | $2,396.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.22 / $329.19 / $580.89
| Facility | | $253.22 | $329.19 | $580.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.76 / $571.77 / $1,075.41
| Professional | | $349.76 | $571.77 | $1,075.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.07 / $461.72 / $6,679.00
| Facility | | $216.07 | $461.72 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.19 / $491.78 / $732.50
| Professional | | $389.19 | $491.78 | $732.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.52 / $580.55 / $921.16
| Professional | | $269.52 | $580.55 | $921.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,449.12 / $3,649.00 / $12,000.00
| Facility | | $1,449.12 | $3,649.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.57 / $896.87 / $2,396.64
| Professional | | $383.57 | $896.87 | $2,396.64 |
- 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
- $371.80 / $505.43 / $1,027.64
| Professional | | $371.80 | $505.43 | $1,027.64 |