- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.82 / $1,886.00 / $3,363.00
| Facility | | $171.82 | $1,886.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.83 / $178.52 / $286.37
| Professional | | $149.83 | $178.52 | $286.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.30 / $2,575.00 / $12,000.00
| Facility | | $445.30 | $2,575.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.61 / $349.52 / $1,295.04
| Professional | | $172.61 | $349.52 | $1,295.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $3,111.82
| Facility | | $443.00 | $500.00 | $3,111.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.17 / $332.34 / $627.39
| Professional | | $183.17 | $332.34 | $627.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.26 / $292.98 / $6,679.00
| Facility | | $168.26 | $292.98 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.20 / $263.68 / $384.61
| Professional | | $207.20 | $263.68 | $384.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.10 / $446.32 / $591.27
| Professional | | $226.10 | $446.32 | $591.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.36 / $4,249.00 / $12,000.00
| Facility | | $1,020.36 | $4,249.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.50 / $349.52 / $1,295.04
| Professional | | $185.50 | $349.52 | $1,295.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $5,714.00
| Facility | | $1,061.00 | $2,854.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.28 / $257.80 / $656.85
| Professional | | $181.28 | $257.80 | $656.85 |