- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $439.96 / $2,618.00 / $3,625.00
| Facility | | $439.96 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.00 / $463.58 / $686.09
| Professional | | $411.00 | $463.58 | $686.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $503.77 / $2,962.75 / $9,011.04
| Facility | | $503.77 | $2,962.75 | $9,011.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.16 / $903.72 / $3,888.00
| Professional | | $482.16 | $903.72 | $3,888.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.35 / $1,918.16 / $1,918.16
| Professional | | $448.35 | $1,918.16 | $1,918.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $3,536.35
| Facility | | $680.00 | $748.00 | $3,536.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.78 / $758.48 / $1,584.79
| Professional | | $464.78 | $758.48 | $1,584.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.00 / $960.66 / $6,679.00
| Facility | | $377.00 | $960.66 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.60 / $650.25 / $955.20
| Professional | | $514.60 | $650.25 | $955.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.29 / $1,119.84 / $1,412.92
| Professional | | $567.29 | $1,119.84 | $1,412.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,424.80 / $9,011.04
| Facility | | $55.00 | $3,424.80 | $9,011.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.62 / $903.72 / $3,888.00
| Professional | | $504.62 | $903.72 | $3,888.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $3,245.00 / $7,608.00
| Facility | | $1,485.00 | $3,245.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.16 / $690.24 / $1,555.35
| Professional | | $482.16 | $690.24 | $1,555.35 |