- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $870.96 / $1,513.56
| Facility | | $501.19 | $870.96 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $436.52 / $1,000.00
| Professional | | $371.54 | $436.52 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,737.80 / $6,309.57
| Facility | | $616.60 | $1,737.80 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.47 / $346.74 / $380.19
| Professional | | $3.47 | $346.74 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,047.13 / $2,290.87
| Facility | | $323.59 | $1,047.13 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $602.56 / $851.14
| Professional | | $245.47 | $602.56 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $851.14 / $1,737.80
| Professional | | $446.68 | $851.14 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Professional | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $1,000.00
| Facility | | $501.19 | $501.19 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $302.00 / $501.19
| Professional | | $208.93 | $302.00 | $501.19 |