- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,445.44 / $2,511.89
| Facility | | $676.08 | $1,445.44 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $426.58 / $602.56
| Professional | | $316.23 | $426.58 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $407.38
| Professional | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $724.44 / $1,584.89
| Facility | | $354.81 | $724.44 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Professional | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $707.95 / $1,148.15
| Professional | | $549.54 | $707.95 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Facility | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $602.56 / $1,000.00
| Professional | | $398.11 | $602.56 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,348.96 / $2,511.89
| Facility | | $645.65 | $1,348.96 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $436.52 / $1,548.82
| Professional | | $316.23 | $436.52 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Professional | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $575.44 / $645.65
| Facility | | $151.36 | $575.44 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $524.81 / $645.65
| Professional | | $151.36 | $524.81 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $630.96
| Facility | | $524.81 | $524.81 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $316.23 / $660.69
| Professional | | $223.87 | $316.23 | $660.69 |