- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.53 / $2,083.00 / $3,625.00
| Facility | | $208.53 | $2,083.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.72 / $214.19 / $580.95
| Professional | | $128.72 | $214.19 | $580.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.10 / $2,871.43 / $10,821.00
| Facility | | $294.10 | $2,871.43 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.16 / $323.58 / $3,577.25
| Professional | | $134.16 | $323.58 | $3,577.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.15 / $186.10 / $328.39
| Facility | | $143.15 | $186.10 | $328.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.79 / $135.79 / $232.48
| Professional | | $135.79 | $135.79 | $232.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.36 / $333.12 / $653.64
| Professional | | $182.36 | $333.12 | $653.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.88 / $300.00 / $6,679.00
| Facility | | $123.88 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.21 / $233.88 / $377.07
| Professional | | $128.21 | $233.88 | $377.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.08 / $331.88 / $551.98
| Professional | | $154.08 | $331.88 | $551.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,447.56 / $1,447.56 / $2,611.80
| Facility | | $1,447.56 | $1,447.56 | $2,611.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.89 / $238.89 / $238.89
| Professional | | $238.89 | $238.89 | $238.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.66 / $3,649.00 / $12,000.00
| Facility | | $612.66 | $3,649.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.50 / $609.79 / $3,577.25
| Professional | | $234.50 | $609.79 | $3,577.25 |
- 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
- $226.96 / $322.52 / $703.05
| Professional | | $226.96 | $322.52 | $703.05 |