- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.10 / $2,747.00 / $4,806.64
| Facility | | $985.10 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.64 / $998.24 / $1,492.78
| Professional | | $847.64 | $998.24 | $1,492.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,375.62 / $9,084.32
| Facility | | $55.00 | $2,375.62 | $9,084.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,003.26 / $1,948.86 / $7,107.68
| Professional | | $1,003.26 | $1,948.86 | $7,107.68 |
- 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
- $833.08 / $1,661.46 / $3,513.56
| Professional | | $833.08 | $1,661.46 | $3,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,608.30 / $6,679.00
| Facility | | $300.00 | $1,608.30 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,137.18 / $1,447.47 / $2,110.85
| Professional | | $1,137.18 | $1,447.47 | $2,110.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,240.27 / $2,428.44 / $3,011.21
| Professional | | $1,240.27 | $2,428.44 | $3,011.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $9,084.32
| Facility | | $55.00 | $2,446.00 | $9,084.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.91 / $1,991.01 / $7,107.68
| Professional | | $1,069.91 | $1,991.01 | $7,107.68 |
- 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
- $1,035.16 / $1,501.08 / $3,243.43
| Professional | | $1,035.16 | $1,501.08 | $3,243.43 |