- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,348.96 / $2,089.30
| Facility | | $295.12 | $1,348.96 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $478.63 / $676.08
| Professional | | $295.12 | $478.63 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,862.09 / $3,388.44
| Facility | | $758.58 | $1,862.09 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $724.44 / $2,089.30
| Professional | | $436.52 | $724.44 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $891.25 / $1,288.25
| Facility | | $724.44 | $891.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $616.60
| Professional | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $562.34 / $1,148.15
| Facility | | $489.78 | $562.34 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $870.96 / $1,047.13
| Professional | | $416.87 | $870.96 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,230.27
| Professional | | $1,047.13 | $1,047.13 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $1,318.26
| Professional | | $724.44 | $724.44 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,862.09 / $3,388.44
| Facility | | $758.58 | $1,862.09 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $724.44 / $2,089.30
| Professional | | $436.52 | $724.44 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $724.44 / $870.96
| Facility | | $436.52 | $724.44 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $575.44 / $1,380.38
| Professional | | $436.52 | $575.44 | $1,380.38 |