- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.63 / $2,747.00 / $4,806.64
| Facility | | $491.63 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.63 / $633.53 / $946.23
| Professional | | $491.63 | $633.53 | $946.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $7,264.24
| Facility | | $55.00 | $2,446.00 | $7,264.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.65 / $1,533.77 / $5,708.72
| Professional | | $686.65 | $1,533.77 | $5,708.72 |
- 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
- $623.38 / $1,575.99 / $3,015.99
| Professional | | $623.38 | $1,575.99 | $3,015.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,504.00 / $9,239.00
| Facility | | $83.43 | $3,504.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,076.89 / $1,076.89 / $1,266.93
| Professional | | $1,076.89 | $1,076.89 | $1,266.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,088.31 / $2,064.52 / $2,500.94
| Professional | | $1,088.31 | $2,064.52 | $2,500.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $7,264.24
| Facility | | $55.00 | $2,446.00 | $7,264.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.80 / $1,514.38 / $5,708.72
| Professional | | $693.80 | $1,514.38 | $5,708.72 |
- 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
- $668.49 / $1,354.59 / $2,588.42
| Professional | | $668.49 | $1,354.59 | $2,588.42 |