- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.49 / $2,747.00 / $4,806.64
| Facility | | $612.49 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.03 / $641.42 / $917.77
| Professional | | $556.03 | $641.42 | $917.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,845.00 / $5,046.30
| Facility | | $55.00 | $1,845.00 | $5,046.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $658.59 / $1,206.26 / $6,421.14
| Professional | | $658.59 | $1,206.26 | $6,421.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.46 / $1,216.53 / $1,647.98
| Professional | | $820.46 | $1,216.53 | $1,647.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $680.00 / $748.00
| Facility | | $50.00 | $680.00 | $748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.62 / $1,052.66 / $2,212.77
| Professional | | $585.62 | $1,052.66 | $2,212.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,014.48 / $6,679.00
| Facility | | $300.00 | $1,014.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.42 / $913.03 / $1,345.32
| Professional | | $720.42 | $913.03 | $1,345.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.06 / $1,525.40 / $1,888.24
| Professional | | $779.06 | $1,525.40 | $1,888.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $5,046.30
| Facility | | $55.00 | $2,446.00 | $5,046.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.90 / $1,206.26 / $6,421.14
| Professional | | $698.90 | $1,206.26 | $6,421.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,446.00 / $4,050.00
| Facility | | $789.00 | $2,446.00 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.35 / $978.46 / $2,025.73
| Professional | | $660.35 | $978.46 | $2,025.73 |