- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.83 / $3,553.00 / $10,836.00
| Facility | | $916.83 | $3,553.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.36 / $995.78 / $1,375.24
| Professional | | $895.36 | $995.78 | $1,375.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.96 / $1,654.72 / $8,230.24
| Facility | | $948.96 | $1,654.72 | $8,230.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.61 / $1,084.26 / $1,510.61
| Professional | | $856.61 | $1,084.26 | $1,510.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.24 / $836.24 / $836.24
| Facility | | $836.24 | $836.24 | $836.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,311.60 / $1,311.60 / $2,273.81
| Professional | | $1,311.60 | $1,311.60 | $2,273.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $7,539.84
| Facility | | $55.00 | $55.00 | $7,539.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,879.36 / $7,031.68 / $7,852.58
| Professional | | $6,879.36 | $7,031.68 | $7,852.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $931.61 / $1,239.58 / $2,090.38
| Facility | | $931.61 | $1,239.58 | $2,090.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.44 / $1,404.04 / $1,651.81
| Professional | | $1,009.44 | $1,404.04 | $1,651.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,354.10 / $1,354.10 / $1,354.10
| Professional | | $1,354.10 | $1,354.10 | $1,354.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $931.61 / $1,245.09 / $2,240.51
| Facility | | $931.61 | $1,245.09 | $2,240.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.85 / $1,610.49 / $2,658.20
| Professional | | $896.85 | $1,610.49 | $2,658.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $2,064.00 / $8,759.00
| Facility | | $385.00 | $2,064.00 | $8,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $788.20 / $1,083.78 / $1,688.40
| Professional | | $788.20 | $1,083.78 | $1,688.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.20 / $896.85 / $1,238.76
| Professional | | $783.20 | $896.85 | $1,238.76 |