- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $726.57 / $2,543.00 / $3,751.49
| Facility | | $726.57 | $2,543.00 | $3,751.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.00 / $726.57 / $1,231.84
| Professional | | $440.00 | $726.57 | $1,231.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,098.15 / $4,128.43 / $8,459.92
| Facility | | $3,098.15 | $4,128.43 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.66 / $699.66 / $699.66
| Professional | | $699.66 | $699.66 | $699.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.55 / $1,166.09 / $2,623.73
| Facility | | $589.55 | $1,166.09 | $2,623.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.25 / $1,012.64 / $2,028.45
| Professional | | $472.25 | $1,012.64 | $2,028.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.50 / $717.60 / $1,515.93
| Professional | | $353.50 | $717.60 | $1,515.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.37 / $180.37 / $180.37
| Facility | | $180.37 | $180.37 | $180.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.45 / $2,543.00 / $3,704.61
| Facility | | $762.45 | $2,543.00 | $3,704.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.77 / $735.54 / $3,704.61
| Professional | | $457.77 | $735.54 | $3,704.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,327.56 / $1,345.50 / $1,794.00
| Professional | | $1,327.56 | $1,345.50 | $1,794.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.54 / $1,304.28 / $2,976.21
| Facility | | $600.54 | $1,304.28 | $2,976.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.19 / $1,012.64 / $2,028.45
| Professional | | $665.19 | $1,012.64 | $2,028.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $897.00 / $897.00 / $986.70
| Facility | | $897.00 | $897.00 | $986.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $897.00 / $897.00 / $986.70
| Professional | | $897.00 | $897.00 | $986.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.74 / $538.20 / $1,390.35
| Professional | | $376.74 | $538.20 | $1,390.35 |