- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.60 / $1,343.59 / $2,313.28
| Facility | | $91.60 | $1,343.59 | $2,313.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.34 / $570.79 / $786.45
| Professional | | $531.34 | $570.79 | $786.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.83 / $1,320.75 / $3,605.49
| Facility | | $560.83 | $1,320.75 | $3,605.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $759.05 / $2,850.26
| Professional | | $455.43 | $759.05 | $2,850.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.33 / $1,664.80 / $3,015.95
| Facility | | $1,083.33 | $1,664.80 | $3,015.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.00 / $645.00 / $751.46
| Professional | | $645.00 | $645.00 | $751.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.89 / $576.40 / $1,479.84
| Facility | | $498.89 | $576.40 | $1,479.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.30 / $682.78 / $3,386.88
| Professional | | $402.30 | $682.78 | $3,386.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,095.45 / $1,095.45 / $1,288.77
| Professional | | $1,095.45 | $1,095.45 | $1,288.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.05 / $759.05 / $2,350.69
| Professional | | $759.05 | $759.05 | $2,350.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.21 / $795.00 / $1,556.72
| Facility | | $762.21 | $795.00 | $1,556.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,320.75 / $3,605.49 / $3,605.49
| Facility | | $1,320.75 | $3,605.49 | $3,605.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.57 / $481.40 / $3,795.25
| Professional | | $341.57 | $481.40 | $3,795.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.45 / $759.05 / $1,225.10
| Facility | | $626.45 | $759.05 | $1,225.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $705.92 / $1,446.80
| Professional | | $455.43 | $705.92 | $1,446.80 |