- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $4,073.80 / $4,897.79
| Facility | | $616.60 | $4,073.80 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $562.34 / $933.25
| Professional | | $436.52 | $562.34 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Professional | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $123.03 / $724.44
| Facility | | $123.03 | $123.03 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,071.52 / $1,071.52
| Professional | | $446.68 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $602.56 / $1,023.29
| Professional | | $407.38 | $602.56 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $4,073.80 / $4,897.79
| Facility | | $645.65 | $4,073.80 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $630.96 / $933.25
| Professional | | $467.74 | $630.96 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $575.44 / $891.25
| Professional | | $354.81 | $575.44 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,000.00 / $1,737.80
| Facility | | $398.11 | $1,000.00 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $602.56 / $812.83
| Professional | | $467.74 | $602.56 | $812.83 |