- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.30 / $2,550.00 / $7,495.00
| Facility | | $597.30 | $2,550.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.55 / $553.30 / $857.12
| Professional | | $394.55 | $553.30 | $857.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,626.73 / $4,846.93 / $9,318.64
| Facility | | $2,626.73 | $4,846.93 | $9,318.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.14 / $513.76 / $728.55
| Professional | | $373.14 | $513.76 | $728.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.64 / $346.64 / $553.00
| Facility | | $346.64 | $346.64 | $553.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,953.70 / $1,953.70 / $2,017.56
| Facility | | $1,953.70 | $1,953.70 | $2,017.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.19 / $567.38 / $827.19
| Professional | | $406.19 | $567.38 | $827.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,803.08 / $16,394.00 / $16,394.00
| Facility | | $2,803.08 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,977.04 / $3,886.08 / $4,458.08
| Professional | | $2,977.04 | $3,886.08 | $4,458.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.22 / $550.86 / $866.86
| Facility | | $389.22 | $550.86 | $866.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.16 / $632.96 / $882.03
| Professional | | $435.16 | $632.96 | $882.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.57 / $514.41 / $623.04
| Professional | | $373.57 | $514.41 | $623.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.22 / $553.86 / $917.35
| Facility | | $389.22 | $553.86 | $917.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.14 / $584.07 / $844.50
| Professional | | $416.14 | $584.07 | $844.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,200.00 / $10,600.00
| Facility | | $1,634.00 | $4,200.00 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.05 / $550.73 / $837.11
| Professional | | $413.05 | $550.73 | $837.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.81 / $499.36 / $703.97
| Professional | | $442.81 | $499.36 | $703.97 |