- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.08 / $8,878.56 / $20,400.00
| Facility | | $811.08 | $8,878.56 | $20,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.04 / $498.26 / $1,947.88
| Professional | | $397.04 | $498.26 | $1,947.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.80 / $822.93 / $1,107.29
| Professional | | $516.80 | $822.93 | $1,107.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.23 / $848.80 / $966.24
| Professional | | $592.23 | $848.80 | $966.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.26 / $755.55 / $1,071.26
| Facility | | $498.26 | $755.55 | $1,071.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.64 / $752.74 / $1,199.96
| Professional | | $603.64 | $752.74 | $1,199.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $547.00 / $721.44 / $767.82
| Facility | | $547.00 | $721.44 | $767.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.26 / $830.35 / $1,059.81
| Facility | | $498.26 | $830.35 | $1,059.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.15 / $885.60 / $1,147.42
| Professional | | $670.15 | $885.60 | $1,147.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,410.73 / $11,450.46 / $14,700.82
| Facility | | $8,410.73 | $11,450.46 | $14,700.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.14 / $901.34 / $1,187.30
| Professional | | $685.14 | $901.34 | $1,187.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,835.00 / $26,404.00
| Facility | | $2,155.00 | $12,835.00 | $26,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.32 / $835.20 / $1,185.17
| Professional | | $567.32 | $835.20 | $1,185.17 |