- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.57 / $2,083.00 / $3,625.00
| Facility | | $268.57 | $2,083.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.71 / $268.57 / $758.41
| Professional | | $178.71 | $268.57 | $758.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.19 / $1,030.90 / $4,569.00
| Facility | | $201.19 | $1,030.90 | $4,569.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.44 / $910.67 / $2,623.27
| Professional | | $292.44 | $910.67 | $2,623.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.65 / $268.12 / $532.05
| Facility | | $208.65 | $268.12 | $532.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.41 / $834.74 / $834.74
| Professional | | $500.41 | $834.74 | $834.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $1,884.25
| Facility | | $680.00 | $748.00 | $1,884.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.06 / $629.02 / $1,607.48
| Professional | | $256.06 | $629.02 | $1,607.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.42 / $300.00 / $6,679.00
| Facility | | $178.42 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.29 / $792.67 / $1,164.41
| Professional | | $627.29 | $792.67 | $1,164.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.00 / $581.62 / $1,466.13
| Professional | | $268.00 | $581.62 | $1,466.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,267.00 / $4,755.00
| Facility | | $55.00 | $1,267.00 | $4,755.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.11 / $1,211.35 / $3,876.64
| Professional | | $671.11 | $1,211.35 | $3,876.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.00 / $2,338.00 / $4,952.00
| Facility | | $669.00 | $2,338.00 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.74 / $1,001.82 / $2,165.02
| Professional | | $604.74 | $1,001.82 | $2,165.02 |