- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,513.56 / $2,398.83
| Facility | | $676.08 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $630.96 / $851.14
| Professional | | $478.63 | $630.96 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $1,258.93
| Professional | | $501.19 | $501.19 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,258.93 / $2,951.21
| Facility | | $512.86 | $1,258.93 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $3,801.89 / $3,801.89
| Professional | | $794.33 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,023.29 / $2,187.76
| Facility | | $676.08 | $1,023.29 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $977.24 / $1,548.82
| Professional | | $562.34 | $977.24 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $776.25 / $1,412.54
| Professional | | $676.08 | $776.25 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,513.56 / $50,118.72
| Facility | | $1,023.29 | $1,513.56 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $812.83
| Professional | | $794.33 | $794.33 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $478.63 / $1,047.13
| Professional | | $331.13 | $478.63 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $912.01
| Facility | | $489.78 | $812.83 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $794.33 / $1,584.89
| Professional | | $676.08 | $794.33 | $1,584.89 |