- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,388.44 / $5,623.41
| Facility | | $1,071.52 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,071.52 / $3,311.31
| Professional | | $912.01 | $1,071.52 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,630.27 / $7,244.36
| Facility | | $56.23 | $2,630.27 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,513.56 / $7,762.47
| Professional | | $912.01 | $1,513.56 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,778.28 / $3,467.37
| Professional | | $954.99 | $1,778.28 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,698.24 / $8,511.38
| Facility | | $302.00 | $1,698.24 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,122.02 / $1,698.24
| Professional | | $602.56 | $1,122.02 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $5,888.44
| Facility | | $1,000.00 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,819.70 / $2,691.53
| Professional | | $1,023.29 | $1,819.70 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,630.27 / $7,244.36
| Facility | | $56.23 | $2,630.27 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,513.56 / $7,762.47
| Professional | | $912.01 | $1,513.56 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,884.03 / $4,677.35
| Facility | | $954.99 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,584.89 / $3,090.30
| Professional | | $1,096.48 | $1,584.89 | $3,090.30 |