- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.36 / $2,079.00 / $3,625.00
| Facility | | $201.36 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.21 / $208.79 / $406.89
| Professional | | $178.21 | $208.79 | $406.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.78 / $3,764.00 / $12,000.00
| Facility | | $459.78 | $3,764.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.15 / $391.89 / $3,162.00
| Professional | | $191.15 | $391.89 | $3,162.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.89 / $284.56 / $502.13
| Facility | | $218.89 | $284.56 | $502.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.87 / $436.90 / $785.49
| Professional | | $278.87 | $436.90 | $785.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.83 / $421.29 / $817.52
| Professional | | $237.83 | $421.29 | $817.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.68 / $399.12 / $6,679.00
| Facility | | $188.68 | $399.12 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.61 / $281.57 / $444.26
| Professional | | $153.61 | $281.57 | $444.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.53 / $500.94 / $706.12
| Professional | | $235.53 | $500.94 | $706.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,859.98 / $1,859.98 / $5,028.10
| Facility | | $1,859.98 | $1,859.98 | $5,028.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.07 / $444.07 / $444.07
| Professional | | $444.07 | $444.07 | $444.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.00 / $4,249.00 / $12,000.00
| Facility | | $933.00 | $4,249.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.77 / $461.05 / $3,162.00
| Professional | | $258.77 | $461.05 | $3,162.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.78 / $332.24 / $740.89
| Professional | | $255.78 | $332.24 | $740.89 |