- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.08 / $2,951.81 / $3,250.93
| Facility | | $669.08 | $2,951.81 | $3,250.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.00 / $637.59 / $669.08
| Professional | | $429.00 | $637.59 | $669.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.98 / $613.98 / $613.98
| Professional | | $613.98 | $613.98 | $613.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.00 / $1,022.69 / $2,352.06
| Facility | | $527.00 | $1,022.69 | $2,352.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,794.06 / $3,794.06 / $3,794.06
| Professional | | $3,794.06 | $3,794.06 | $3,794.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $826.51 / $1,062.65 / $1,944.26
| Professional | | $826.51 | $1,062.65 | $1,944.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,211.42 / $3,250.93 / $3,250.93
| Facility | | $1,211.42 | $3,250.93 | $3,250.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.61 / $645.46 / $3,250.93
| Professional | | $516.61 | $645.46 | $3,250.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,164.98 / $1,180.72 / $1,574.30
| Professional | | $1,164.98 | $1,180.72 | $1,574.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.49 / $994.44 / $2,612.19
| Facility | | $548.49 | $994.44 | $2,612.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,794.06 / $3,794.06 / $3,794.06
| Professional | | $3,794.06 | $3,794.06 | $3,794.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.15 / $787.15 / $865.87
| Facility | | $787.15 | $787.15 | $865.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.15 / $787.15 / $865.87
| Professional | | $787.15 | $787.15 | $865.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.29 / $472.29 / $944.58
| Facility | | $472.29 | $472.29 | $944.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.60 / $472.29 / $1,440.48
| Professional | | $330.60 | $472.29 | $1,440.48 |