- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.01 / $2,783.00 / $7,542.00
| Facility | | $706.01 | $2,783.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.97 / $778.33 / $1,317.06
| Professional | | $681.97 | $778.33 | $1,317.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.79 / $898.42 / $1,224.26
| Professional | | $709.79 | $898.42 | $1,224.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $705.13 / $715.49
| Facility | | $80.00 | $705.13 | $715.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.54 / $874.54 / $874.54
| Facility | | $874.54 | $874.54 | $874.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.75 / $1,014.79 / $1,561.22
| Professional | | $755.75 | $1,014.79 | $1,561.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,330.92 / $16,394.00 / $19,913.50
| Facility | | $4,330.92 | $16,394.00 | $19,913.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,170.75 / $7,170.75 / $7,170.75
| Professional | | $7,170.75 | $7,170.75 | $7,170.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.03 / $956.53 / $1,560.36
| Facility | | $739.03 | $956.53 | $1,560.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $950.59 / $1,140.71 / $1,414.47
| Professional | | $950.59 | $1,140.71 | $1,414.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.00 / $995.00 / $995.00
| Professional | | $995.00 | $995.00 | $995.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.47 / $958.67 / $1,658.50
| Facility | | $740.47 | $958.67 | $1,658.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.65 / $1,042.81 / $1,595.95
| Professional | | $774.65 | $1,042.81 | $1,595.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,345.00 / $10,600.00
| Facility | | $1,634.00 | $4,345.00 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.62 / $829.10 / $1,306.08
| Professional | | $598.62 | $829.10 | $1,306.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.04 / $735.79 / $1,023.88
| Professional | | $649.04 | $735.79 | $1,023.88 |