- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.51 / $2,363.67 / $4,979.37
| Facility | | $713.51 | $2,363.67 | $4,979.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.34 / $713.51 / $736.28
| Professional | | $531.34 | $713.51 | $736.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $797.00 / $1,214.48 / $3,135.94
| Facility | | $797.00 | $1,214.48 | $3,135.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.15 / $1,554.62 / $5,692.88
| Professional | | $683.15 | $1,554.62 | $5,692.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.41 / $1,613.50 / $1,959.95
| Facility | | $789.41 | $1,613.50 | $1,959.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.14 / $759.05 / $1,897.62
| Facility | | $683.14 | $759.05 | $1,897.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.14 / $759.05 / $1,897.62
| Professional | | $683.14 | $759.05 | $1,897.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $75.00
| Professional | | $75.00 | $75.00 | $75.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.15 / $834.96 / $1,328.34
| Facility | | $683.15 | $834.96 | $1,328.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.05 / $1,328.34 / $2,277.15
| Facility | | $759.05 | $1,328.34 | $2,277.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.15 / $948.81 / $1,146.17
| Professional | | $683.15 | $948.81 | $1,146.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $797.00 / $1,214.48 / $2,087.39
| Facility | | $797.00 | $1,214.48 | $2,087.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.51 / $1,476.89 / $1,764.72
| Professional | | $839.51 | $1,476.89 | $1,764.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.10 / $759.05 / $759.05
| Facility | | $721.10 | $759.05 | $759.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $318.80 / $850.14
| Professional | | $318.80 | $318.80 | $850.14 |