- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.55 / $1,593.70 / $3,363.00
| Facility | | $671.55 | $1,593.70 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.38 / $362.00 / $890.73
| Professional | | $148.38 | $362.00 | $890.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.20 / $2,871.43 / $10,821.00
| Facility | | $301.20 | $2,871.43 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.40 / $784.56 / $3,562.64
| Professional | | $137.40 | $784.56 | $3,562.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.27 / $186.25 / $366.05
| Facility | | $143.27 | $186.25 | $366.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.81 / $444.14 / $1,337.36
| Professional | | $182.81 | $444.14 | $1,337.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.33 / $663.09 / $1,785.48
| Professional | | $189.33 | $663.09 | $1,785.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.46 / $300.00 / $6,679.00
| Facility | | $125.46 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.58 / $556.85 / $856.70
| Professional | | $310.58 | $556.85 | $856.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.02 / $607.85 / $1,349.49
| Professional | | $157.02 | $607.85 | $1,349.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,037.47 / $1,859.98 / $3,474.92
| Facility | | $1,037.47 | $1,859.98 | $3,474.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.69 / $194.93 / $387.99
| Professional | | $165.69 | $194.93 | $387.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $997.22 / $3,649.00 / $12,000.00
| Facility | | $997.22 | $3,649.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.56 / $1,343.75 / $3,562.64
| Professional | | $203.56 | $1,343.75 | $3,562.64 |
- 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
- $177.27 / $812.78 / $2,017.19
| Professional | | $177.27 | $812.78 | $2,017.19 |