- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.01 / $2,594.00 / $7,542.00
| Facility | | $694.01 | $2,594.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.65 / $694.01 / $1,004.06
| Professional | | $614.65 | $694.01 | $1,004.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.61 / $665.30 / $926.91
| Professional | | $525.61 | $665.30 | $926.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.53 / $600.53 / $600.53
| Facility | | $600.53 | $600.53 | $600.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,024.00 / $4,479.10 / $5,307.74
| Facility | | $2,024.00 | $4,479.10 | $5,307.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.49 / $850.14 / $1,347.27
| Professional | | $616.49 | $850.14 | $1,347.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $20,973.00
| Facility | | $55.00 | $55.00 | $20,973.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,801.92 / $4,939.28 / $5,613.83
| Professional | | $4,801.92 | $4,939.28 | $5,613.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $621.28 / $762.67 / $1,448.12
| Facility | | $621.28 | $762.67 | $1,448.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.72 / $990.80 / $1,204.50
| Professional | | $744.72 | $990.80 | $1,204.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,296.80 / $1,767.80
| Professional | | $5.00 | $1,296.80 | $1,767.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $623.80 / $779.76 / $1,485.10
| Facility | | $623.80 | $779.76 | $1,485.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.37 / $893.83 / $1,653.54
| Professional | | $634.37 | $893.83 | $1,653.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,182.00 / $6,414.00 / $13,429.00
| Facility | | $2,182.00 | $6,414.00 | $13,429.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.37 / $718.60 / $1,114.80
| Professional | | $543.37 | $718.60 | $1,114.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.69 / $646.05 / $875.87
| Professional | | $552.69 | $646.05 | $875.87 |