- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $824.28 / $2,845.54 / $2,845.54
| Facility | | $824.28 | $2,845.54 | $2,845.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.84 / $767.28 / $1,076.08
| Professional | | $585.84 | $767.28 | $1,076.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.85 / $951.27 / $2,491.46
| Professional | | $623.85 | $951.27 | $2,491.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,006.79 / $2,345.10 / $3,597.44
| Facility | | $2,006.79 | $2,345.10 | $3,597.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.62 / $1,724.42 / $2,549.27
| Professional | | $754.62 | $1,724.42 | $2,549.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $665.60 / $820.12 / $1,452.57
| Facility | | $665.60 | $820.12 | $1,452.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.80 / $820.12 / $1,525.66
| Facility | | $670.80 | $820.12 | $1,525.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.98 / $1,096.58 / $5,409.99
| Professional | | $661.98 | $1,096.58 | $5,409.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.02 / $706.86 / $1,484.63
| Professional | | $426.02 | $706.86 | $1,484.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $665.60 / $811.52 / $1,497.69
| Facility | | $665.60 | $811.52 | $1,497.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.30 / $1,763.96 / $2,515.69
| Professional | | $1,201.30 | $1,763.96 | $2,515.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.11 / $1,539.85 / $3,462.08
| Facility | | $876.11 | $1,539.85 | $3,462.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.22 / $3,275.19 / $5,409.99
| Professional | | $812.22 | $3,275.19 | $5,409.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.88 / $1,244.04 / $2,680.48
| Professional | | $884.88 | $1,244.04 | $2,680.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.97 / $1,076.41 / $2,329.48
| Professional | | $659.97 | $1,076.41 | $2,329.48 |