- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $406.80 / $2,067.00 / $3,625.00
| Facility | | $406.80 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.97 / $406.80 / $808.22
| Professional | | $281.97 | $406.80 | $808.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $3,372.00 / $10,821.00
| Facility | | $818.35 | $3,372.00 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.30 / $844.73 / $3,351.52
| Professional | | $341.30 | $844.73 | $3,351.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.91 / $513.38 / $905.92
| Facility | | $394.91 | $513.38 | $905.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.61 / $647.61 / $933.84
| Professional | | $647.61 | $647.61 | $933.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.39 / $886.17 / $1,489.35
| Professional | | $487.39 | $886.17 | $1,489.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.85 / $720.08 / $6,679.00
| Facility | | $329.85 | $720.08 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.37 / $682.82 / $1,207.65
| Professional | | $540.37 | $682.82 | $1,207.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.22 / $890.31 / $1,273.08
| Professional | | $415.22 | $890.31 | $1,273.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,637.68 / $1,637.68 / $1,637.68
| Facility | | $1,637.68 | $1,637.68 | $1,637.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.00 / $489.00 / $901.69
| Professional | | $489.00 | $489.00 | $901.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,649.00 / $12,000.00
| Facility | | $1,640.00 | $3,649.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.07 / $1,266.38 / $3,351.52
| Professional | | $482.07 | $1,266.38 | $3,351.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.00 / $3,592.00 / $8,498.00
| Facility | | $1,450.00 | $3,592.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.86 / $747.86 / $1,647.38
| Professional | | $393.86 | $747.86 | $1,647.38 |