- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.62 / $2,410.00 / $4,333.78
| Facility | | $270.62 | $2,410.00 | $4,333.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.47 / $376.02 / $1,250.00
| Professional | | $249.47 | $376.02 | $1,250.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.53 / $3,764.00 / $12,379.00
| Facility | | $629.53 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.57 / $564.88 / $2,260.36
| Professional | | $263.57 | $564.88 | $2,260.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.54 / $391.40 / $691.73
| Facility | | $301.54 | $391.40 | $691.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.05 / $494.47 / $962.28
| Professional | | $96.05 | $494.47 | $962.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.80 / $545.66 / $1,124.51
| Professional | | $325.80 | $545.66 | $1,124.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.94 / $549.84 / $6,679.00
| Facility | | $259.94 | $549.84 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.18 / $346.38 / $558.44
| Professional | | $188.18 | $346.38 | $558.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.83 / $662.56 / $928.35
| Professional | | $316.83 | $662.56 | $928.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,199.96 / $1,859.98 / $5,925.25
| Facility | | $1,199.96 | $1,859.98 | $5,925.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.58 / $493.78 / $780.78
| Professional | | $405.58 | $493.78 | $780.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.16 / $4,249.00 / $20,000.00
| Facility | | $1,285.16 | $4,249.00 | $20,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.04 / $694.85 / $2,260.36
| Professional | | $339.04 | $694.85 | $2,260.36 |
- 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
- $329.82 / $443.42 / $936.77
| Professional | | $329.82 | $443.42 | $936.77 |