- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.50 / $1,181.00 / $7,439.00
| Facility | | $603.50 | $1,181.00 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.28 / $615.21 / $1,130.06
| Professional | | $559.28 | $615.21 | $1,130.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.36 / $2,503.36 / $2,539.89
| Facility | | $2,503.36 | $2,503.36 | $2,539.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.44 / $949.05 / $1,624.65
| Professional | | $522.44 | $949.05 | $1,624.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.22 / $852.74 / $1,532.93
| Professional | | $636.22 | $852.74 | $1,532.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.50 / $735.34 / $1,189.75
| Facility | | $603.50 | $735.34 | $1,189.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.34 / $761.00 / $808.00
| Professional | | $735.34 | $761.00 | $808.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $823.70 / $1,621.70
| Professional | | $3.00 | $823.70 | $1,621.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.33 / $740.52 / $1,613.84
| Professional | | $513.33 | $740.52 | $1,613.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $7,817.95 / $8,957.00
| Facility | | $55.00 | $7,817.95 | $8,957.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,515.68 / $4,515.68 / $5,382.98
| Professional | | $4,515.68 | $4,515.68 | $5,382.98 |