- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $2,663.12 / $3,693.00
| Facility | | $1,485.00 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.60 / $527.38 / $1,169.09
| Professional | | $351.60 | $527.38 | $1,169.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.96 / $1,759.00 / $4,256.00
| Facility | | $517.96 | $1,759.00 | $4,256.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.30 / $889.11 / $3,255.36
| Professional | | $470.30 | $889.11 | $3,255.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.01 / $882.56 / $1,521.52
| Professional | | $641.01 | $882.56 | $1,521.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.80 / $944.78 / $1,742.12
| Professional | | $510.80 | $944.78 | $1,742.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.07 / $981.36 / $6,679.00
| Facility | | $455.07 | $981.36 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.55 / $522.19 / $841.88
| Professional | | $281.55 | $522.19 | $841.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.66 / $1,139.23 / $1,446.44
| Professional | | $574.66 | $1,139.23 | $1,446.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $5,876.00
| Facility | | $55.00 | $2,446.00 | $5,876.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.65 / $981.36 / $3,255.36
| Professional | | $518.65 | $981.36 | $3,255.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,325.00 / $4,662.00
| Facility | | $953.00 | $3,325.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.65 / $671.28 / $1,345.78
| Professional | | $512.65 | $671.28 | $1,345.78 |