- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.78 / $750.78 / $750.78
| Facility | | $750.78 | $750.78 | $750.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.78 / $1,029.28 / $2,467.96
| Professional | | $750.78 | $1,029.28 | $2,467.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,909.90 / $7,000.24
| Facility | | $789.00 | $2,909.90 | $7,000.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $992.08 / $1,752.48 / $6,480.32
| Professional | | $992.08 | $1,752.48 | $6,480.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,249.93 / $1,720.94 / $2,966.88
| Professional | | $1,249.93 | $1,720.94 | $2,966.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.13 / $1,867.32 / $3,384.33
| Professional | | $1,001.13 | $1,867.32 | $3,384.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,435.22 / $8,090.00
| Facility | | $300.00 | $1,435.22 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.05 / $1,055.93 / $1,663.17
| Professional | | $554.05 | $1,055.93 | $1,663.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,153.02 / $2,285.75 / $2,902.15
| Professional | | $1,153.02 | $2,285.75 | $2,902.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.41 / $210.41 / $210.41
| Professional | | $210.41 | $210.41 | $210.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $7,231.00
| Facility | | $55.00 | $2,854.00 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,179.08 / $1,853.41 / $6,480.32
| Professional | | $1,179.08 | $1,853.41 | $6,480.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,325.00 / $4,662.00
| Facility | | $953.00 | $3,325.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,081.01 / $1,535.26 / $2,597.57
| Professional | | $1,081.01 | $1,535.26 | $2,597.57 |