- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.88 / $2,962.96 / $6,915.00
| Facility | | $610.88 | $2,962.96 | $6,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.06 / $424.19 / $896.78
| Professional | | $222.06 | $424.19 | $896.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.60 / $468.66 / $647.34
| Professional | | $444.60 | $468.66 | $647.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.77 / $712.15 / $1,029.71
| Professional | | $350.77 | $712.15 | $1,029.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.54 / $517.54 / $891.97
| Professional | | $264.54 | $517.54 | $891.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.06 / $459.69 / $868.81
| Facility | | $222.06 | $459.69 | $868.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.62 / $554.62 / $898.26
| Professional | | $554.62 | $554.62 | $898.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,928.40 / $2,928.40 / $2,928.40
| Facility | | $2,928.40 | $2,928.40 | $2,928.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $590.90 / $887.70
| Professional | | $3.00 | $590.90 | $887.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,353.00 / $6,575.00 / $9,616.00
| Facility | | $2,353.00 | $6,575.00 | $9,616.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.56 / $537.49 / $1,000.32
| Professional | | $355.56 | $537.49 | $1,000.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.68 / $1,172.68 / $16,394.00
| Facility | | $1,172.68 | $1,172.68 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,690.48 / $3,132.62 / $3,132.62
| Professional | | $1,690.48 | $3,132.62 | $3,132.62 |