- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.08 / $5,360.00 / $9,975.00
| Facility | | $653.08 | $5,360.00 | $9,975.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.04 / $642.73 / $800.34
| Professional | | $539.04 | $642.73 | $800.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.60 / $670.85 / $920.07
| Professional | | $524.60 | $670.85 | $920.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.19 / $910.11 / $5,036.00
| Professional | | $631.19 | $910.11 | $5,036.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.50 / $759.59 / $1,410.92
| Professional | | $571.50 | $759.59 | $1,410.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.91 / $651.50 / $803.52
| Professional | | $542.91 | $651.50 | $803.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.00 / $788.81 / $1,155.69
| Facility | | $635.00 | $788.81 | $1,155.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $711.00 / $790.00 / $1,333.90
| Professional | | $711.00 | $790.00 | $1,333.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.85 / $757.65 / $3,512.00
| Facility | | $560.85 | $757.65 | $3,512.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.85 / $757.65 / $3,512.00
| Professional | | $560.85 | $757.65 | $3,512.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,349.00 / $7,061.00 / $13,741.00
| Facility | | $4,349.00 | $7,061.00 | $13,741.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.59 / $773.87 / $1,247.31
| Professional | | $494.59 | $773.87 | $1,247.31 |