- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,122.02 / $2,089.30
| Facility | | $467.74 | $1,122.02 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $467.74 / $1,479.11
| Professional | | $363.08 | $467.74 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $691.83 / $1,737.80
| Facility | | $446.68 | $691.83 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $512.86 / $3,981.07
| Professional | | $295.12 | $512.86 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,202.26 / $1,905.46
| Facility | | $954.99 | $1,202.26 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $478.63
| Professional | | $457.09 | $457.09 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $831.76 / $1,905.46
| Facility | | $389.05 | $831.76 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $588.84 / $1,288.25
| Professional | | $295.12 | $588.84 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $3,630.78 / $9,772.37
| Facility | | $83.18 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $831.76
| Professional | | $707.95 | $707.95 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $1,047.13
| Professional | | $489.78 | $489.78 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $691.83 / $1,737.80
| Facility | | $446.68 | $691.83 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $512.86 / $3,981.07
| Professional | | $295.12 | $512.86 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $489.78 / $794.33
| Facility | | $407.38 | $489.78 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $489.78 / $1,000.00
| Professional | | $295.12 | $489.78 | $1,000.00 |