- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.96 / $2,663.12 / $3,625.00
| Facility | | $1,248.96 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.13 / $1,248.96 / $2,595.69
| Professional | | $134.13 | $1,248.96 | $2,595.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,338.00 / $1,338.00 / $1,338.00
| Professional | 50 | $1,338.00 | $1,338.00 | $1,338.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.62 / $2,338.00 / $4,952.00
| Facility | | $326.62 | $2,338.00 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.88 / $2,220.85 / $6,037.33
| Professional | | $155.88 | $2,220.85 | $6,037.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.89 / $216.96 / $425.57
| Facility | | $166.89 | $216.96 | $425.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.73 / $1,607.43 / $2,885.18
| Professional | | $235.73 | $1,607.43 | $2,885.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.81 / $773.73 / $5,052.63
| Professional | | $262.81 | $773.73 | $5,052.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.88 / $228.23 / $6,679.00
| Facility | | $146.88 | $228.23 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,612.26 / $1,905.14 / $3,391.30
| Professional | | $1,612.26 | $1,905.14 | $3,391.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.09 / $1,572.45 / $3,640.06
| Professional | | $183.09 | $1,572.45 | $3,640.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,376.00 / $8,498.00
| Facility | | $55.00 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,095.87 / $3,631.91 / $9,721.28
| Professional | | $2,095.87 | $3,631.91 | $9,721.28 |
- 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
- $2,051.69 / $2,769.00 / $6,166.91
| Professional | | $2,051.69 | $2,769.00 | $6,166.91 |