- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.11 / $3,570.00 / $10,893.00
| Facility | | $807.11 | $3,570.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.47 / $807.11 / $1,195.04
| Professional | | $713.47 | $807.11 | $1,195.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.70 / $873.40 / $1,248.15
| Professional | | $718.70 | $873.40 | $1,248.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.36 / $725.36 / $750.83
| Facility | | $725.36 | $725.36 | $750.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $893.51 / $2,024.00 / $4,619.00
| Facility | | $893.51 | $2,024.00 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.07 / $1,012.22 / $1,584.71
| Professional | | $698.07 | $1,012.22 | $1,584.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $6,209.56
| Facility | | $55.00 | $55.00 | $6,209.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,555.92 / $5,682.16 / $6,787.73
| Professional | | $5,555.92 | $5,682.16 | $6,787.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.74 / $870.83 / $1,592.58
| Facility | | $715.74 | $870.83 | $1,592.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $883.10 / $1,174.90 / $1,382.24
| Professional | | $883.10 | $1,174.90 | $1,382.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $829.80 / $1,986.80
| Professional | | $6.00 | $829.80 | $1,986.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.86 / $872.82 / $1,752.58
| Facility | | $718.86 | $872.82 | $1,752.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.90 / $1,079.99 / $1,959.63
| Professional | | $746.90 | $1,079.99 | $1,959.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,970.00 / $8,583.00
| Facility | | $385.00 | $1,970.00 | $8,583.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.95 / $841.74 / $1,347.13
| Professional | | $617.95 | $841.74 | $1,347.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.39 / $761.72 / $1,027.96
| Professional | | $655.39 | $761.72 | $1,027.96 |