- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.09 / $2,594.00 / $7,542.00
| Facility | | $728.09 | $2,594.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.06 / $789.52 / $1,045.56
| Professional | | $659.06 | $789.52 | $1,045.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $658.38 / $834.21 / $1,161.05
| Professional | | $658.38 | $834.21 | $1,161.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.66 / $626.66 / $626.66
| Facility | | $626.66 | $626.66 | $626.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.00 / $946.48 / $1,492.62
| Professional | | $704.00 | $946.48 | $1,492.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $5,635.28
| Facility | | $55.00 | $55.00 | $5,635.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,090.88 / $5,256.40 / $5,935.50
| Professional | | $5,090.88 | $5,256.40 | $5,935.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.96 / $892.68 / $1,577.73
| Facility | | $683.96 | $892.68 | $1,577.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.48 / $1,049.20 / $1,234.34
| Professional | | $891.48 | $1,049.20 | $1,234.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $814.30 / $814.30 / $814.30
| Professional | | $814.30 | $814.30 | $814.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.33 / $917.90 / $1,749.91
| Facility | | $673.33 | $917.90 | $1,749.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.34 / $964.34 / $1,523.51
| Professional | | $710.34 | $964.34 | $1,523.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $564.00 / $2,064.00 / $4,509.00
| Facility | | $564.00 | $2,064.00 | $4,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.82 / $793.83 / $1,237.63
| Professional | | $587.82 | $793.83 | $1,237.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.27 / $662.17 / $927.02
| Professional | | $585.27 | $662.17 | $927.02 |