- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.00 / $3,748.00 / $8,017.00
| Facility | | $768.00 | $3,748.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.66 / $688.67 / $804.53
| Professional | | $613.66 | $688.67 | $804.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,800.00 / $11,479.00 / $17,952.00
| Facility | | $5,800.00 | $11,479.00 | $17,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.40 / $748.71 / $1,086.98
| Professional | | $506.40 | $748.71 | $1,086.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.13 / $780.09 / $1,281.41
| Professional | | $556.13 | $780.09 | $1,281.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $873.28 / $873.28 / $923.20
| Professional | | $873.28 | $873.28 | $923.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,964.00 / $8,017.00
| Facility | | $954.00 | $3,964.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.96 / $716.40 / $3,494.00
| Professional | | $553.96 | $716.40 | $3,494.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,097.50 / $1,418.50
| Professional | | $3.00 | $1,097.50 | $1,418.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.77 / $806.38 / $1,298.73
| Professional | | $595.77 | $806.38 | $1,298.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.02 / $562.02 / $797.20
| Facility | | $562.02 | $562.02 | $797.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.16 / $573.26 / $797.20
| Professional | | $536.16 | $573.26 | $797.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.00 / $3,475.00 / $6,000.00
| Facility | | $1,440.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.69 / $748.73 / $1,194.40
| Professional | | $568.69 | $748.73 | $1,194.40 |