- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.68 / $1,602.00 / $2,382.10
| Facility | | $485.68 | $1,602.00 | $2,382.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.08 / $485.68 / $595.80
| Professional | | $401.08 | $485.68 | $595.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.88 / $724.41 / $2,079.52
| Professional | | $423.88 | $724.41 | $2,079.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,256.16 / $1,467.92 / $2,251.83
| Facility | | $1,256.16 | $1,467.92 | $2,251.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.75 / $1,128.38 / $1,494.50
| Professional | | $606.75 | $1,128.38 | $1,494.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.34 / $500.82 / $763.97
| Facility | | $424.34 | $500.82 | $763.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.95 / $500.91 / $796.22
| Facility | | $417.95 | $500.91 | $796.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.51 / $778.13 / $2,826.03
| Professional | | $441.51 | $778.13 | $2,826.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.40 / $70.00 / $1,089.00
| Professional | | $58.40 | $70.00 | $1,089.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.34 / $500.82 / $763.97
| Facility | | $424.34 | $500.82 | $763.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.20 / $1,112.99 / $1,561.04
| Professional | | $620.20 | $1,112.99 | $1,561.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,184.44 / $2,184.44 / $2,184.44
| Facility | | $2,184.44 | $2,184.44 | $2,184.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.78 / $2,050.25 / $2,826.03
| Professional | | $737.78 | $2,050.25 | $2,826.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.72 / $473.72 / $473.72
| Professional | | $473.72 | $473.72 | $473.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.15 / $2,316.90 / $2,316.90
| Professional | | $592.15 | $2,316.90 | $2,316.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.70 / $746.65 / $1,538.91
| Professional | | $438.70 | $746.65 | $1,538.91 |