- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.00 / $2,416.01 / $2,850.90
| Facility | | $711.00 | $2,416.01 | $2,850.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.85 / $559.13 / $586.75
| Professional | | $365.85 | $559.13 | $586.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.42 / $538.42 / $538.42
| Professional | | $538.42 | $538.42 | $538.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.09 / $945.78 / $2,290.56
| Facility | | $655.09 | $945.78 | $2,290.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,327.20 / $3,327.20 / $3,327.20
| Professional | | $3,327.20 | $3,327.20 | $3,327.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.80 / $931.89 / $1,705.02
| Professional | | $724.80 | $931.89 | $1,705.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.34 / $2,850.90 / $2,850.90
| Facility | | $1,062.34 | $2,850.90 | $2,850.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.04 / $586.75 / $2,850.90
| Professional | | $453.04 | $586.75 | $2,850.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,021.63 / $1,035.43 / $1,380.58
| Professional | | $1,021.63 | $1,035.43 | $1,380.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.88 / $1,068.48 / $2,290.56
| Facility | | $671.88 | $1,068.48 | $2,290.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,327.20 / $3,327.20 / $3,327.20
| Professional | | $3,327.20 | $3,327.20 | $3,327.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.29 / $690.29 / $759.32
| Facility | | $690.29 | $690.29 | $759.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.29 / $690.29 / $759.32
| Professional | | $690.29 | $690.29 | $759.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.92 / $414.17 / $921.68
| Professional | | $289.92 | $414.17 | $921.68 |