- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.00 / $2,550.00 / $7,542.00
| Facility | | $714.00 | $2,550.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.75 / $830.22 / $1,389.41
| Professional | | $708.75 | $830.22 | $1,389.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,722.08 / $4,243.05 / $7,719.61
| Facility | | $1,722.08 | $4,243.05 | $7,719.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.66 / $906.21 / $1,341.08
| Professional | | $719.66 | $906.21 | $1,341.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $733.85 / $748.27
| Facility | | $80.00 | $733.85 | $748.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,333.12 / $1,333.12 / $1,333.12
| Facility | | $1,333.12 | $1,333.12 | $1,333.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.88 / $1,068.75 / $1,623.74
| Professional | | $800.88 | $1,068.75 | $1,623.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,665.60 / $11,500.00 / $16,394.00
| Facility | | $3,665.60 | $11,500.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,653.36 / $6,642.56 / $7,900.73
| Professional | | $5,653.36 | $6,642.56 | $7,900.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $753.59 / $992.25 / $1,590.40
| Facility | | $753.59 | $992.25 | $1,590.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.05 / $1,257.11 / $1,616.29
| Professional | | $1,010.05 | $1,257.11 | $1,616.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $850.20 / $1,015.00 / $1,507.39
| Professional | | $850.20 | $1,015.00 | $1,507.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $753.59 / $995.50 / $1,636.28
| Facility | | $753.59 | $995.50 | $1,636.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.72 / $1,135.65 / $1,731.31
| Professional | | $820.72 | $1,135.65 | $1,731.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.00 / $2,100.00 / $4,554.00
| Facility | | $600.00 | $2,100.00 | $4,554.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.60 / $944.86 / $1,457.38
| Professional | | $686.60 | $944.86 | $1,457.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.36 / $865.65 / $1,208.33
| Professional | | $766.36 | $865.65 | $1,208.33 |