- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.35 / $2,083.00 / $3,625.00
| Facility | | $225.35 | $2,083.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.84 / $260.97 / $388.46
| Professional | | $204.84 | $260.97 | $388.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.87 / $1,695.92 / $7,929.30
| Facility | | $307.87 | $1,695.92 | $7,929.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.04 / $523.30 / $1,965.84
| Professional | | $243.04 | $523.30 | $1,965.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.73 / $1,695.28 / $1,695.28
| Professional | | $601.73 | $1,695.28 | $1,695.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $3,111.82
| Facility | | $680.00 | $748.00 | $3,111.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.41 / $455.97 / $964.86
| Professional | | $238.41 | $455.97 | $964.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.17 / $452.96 / $6,679.00
| Facility | | $276.17 | $452.96 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.91 / $407.66 / $588.24
| Professional | | $316.91 | $407.66 | $588.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.61 / $674.34 / $893.34
| Professional | | $341.61 | $674.34 | $893.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,329.00 / $7,929.30
| Facility | | $55.00 | $2,329.00 | $7,929.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.95 / $524.19 / $1,965.84
| Professional | | $265.95 | $524.19 | $1,965.84 |
- 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
- $243.30 / $379.19 / $924.06
| Professional | | $243.30 | $379.19 | $924.06 |