- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.51 / $3,633.00 / $8,920.00
| Facility | | $586.51 | $3,633.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.67 / $509.74 / $586.51
| Professional | | $460.67 | $509.74 | $586.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,735.00 / $2,390.00 / $2,954.00
| Facility | | $1,735.00 | $2,390.00 | $2,954.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.73 / $613.47 / $841.37
| Professional | | $479.73 | $613.47 | $841.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.35 / $691.00 / $1,136.65
| Professional | | $575.35 | $691.00 | $1,136.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.56 / $676.84 / $1,298.25
| Professional | | $504.56 | $676.84 | $1,298.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.11 / $578.53 / $713.52
| Professional | | $482.11 | $578.53 | $713.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.74 / $677.68 / $958.14
| Facility | | $509.74 | $677.68 | $958.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.00 / $724.00 / $1,157.00
| Professional | | $590.00 | $724.00 | $1,157.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $503.47 / $696.67 / $1,256.79
| Facility | | $503.47 | $696.67 | $1,256.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.47 / $696.67 / $1,256.79
| Professional | | $503.47 | $696.67 | $1,256.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.00 / $1,045.00 / $2,364.00
| Facility | | $296.00 | $1,045.00 | $2,364.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.41 / $622.10 / $1,081.10
| Professional | | $406.41 | $622.10 | $1,081.10 |