- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $647.41 / $2,550.00 / $7,495.00
| Facility | | $647.41 | $2,550.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.31 / $616.14 / $963.88
| Professional | | $494.31 | $616.14 | $963.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,460.47 / $2,568.40 / $4,940.55
| Facility | | $1,460.47 | $2,568.40 | $4,940.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.97 / $695.05 / $1,008.30
| Professional | | $551.97 | $695.05 | $1,008.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.46 / $535.46 / $746.34
| Facility | | $535.46 | $535.46 | $746.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.67 / $766.39 / $1,139.09
| Professional | | $586.67 | $766.39 | $1,139.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,046.94 / $16,394.00 / $16,394.00
| Facility | | $3,046.94 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,326.32 / $5,170.88 / $6,114.98
| Professional | | $4,326.32 | $5,170.88 | $6,114.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.54 / $723.82 / $1,012.59
| Facility | | $558.54 | $723.82 | $1,012.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.60 / $982.24 / $1,304.98
| Professional | | $701.60 | $982.24 | $1,304.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.70 / $725.04 / $982.35
| Professional | | $567.70 | $725.04 | $982.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.54 / $723.82 / $1,052.52
| Facility | | $558.54 | $723.82 | $1,052.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.47 / $793.73 / $1,240.13
| Professional | | $596.47 | $793.73 | $1,240.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.00 / $3,314.00 / $7,600.00
| Facility | | $1,124.00 | $3,314.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.53 / $744.47 / $1,066.65
| Professional | | $550.53 | $744.47 | $1,066.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.79 / $675.91 / $946.27
| Professional | | $598.79 | $675.91 | $946.27 |