- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,094.00 / $3,685.00
| Facility | | $988.00 | $2,094.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.96 / $483.36 / $784.68
| Professional | | $444.96 | $483.36 | $784.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $2,826.85 / $8,498.00
| Facility | | $941.10 | $2,826.85 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.32 / $847.24 / $3,644.24
| Professional | | $492.32 | $847.24 | $3,644.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.54 / $996.26 / $1,349.67
| Professional | | $607.54 | $996.26 | $1,349.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.47 / $795.95 / $1,417.72
| Professional | | $483.47 | $795.95 | $1,417.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.38 / $1,107.80 / $6,679.00
| Facility | | $508.38 | $1,107.80 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.37 / $706.65 / $974.86
| Professional | | $583.37 | $706.65 | $974.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.33 / $1,245.59 / $1,643.15
| Professional | | $628.33 | $1,245.59 | $1,643.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,592.00 / $12,000.00
| Facility | | $1,640.00 | $3,592.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.23 / $910.93 / $3,644.24
| Professional | | $518.23 | $910.93 | $3,644.24 |
- 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
- $505.25 / $765.03 / $1,496.80
| Professional | | $505.25 | $765.03 | $1,496.80 |