- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.67 / $1,030.31 / $6,172.07
| Facility | | $733.67 | $1,030.31 | $6,172.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.67 / $733.67 / $924.42
| Professional | | $733.67 | $733.67 | $924.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.72 / $1,146.43 / $3,668.35
| Facility | | $572.72 | $1,146.43 | $3,668.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.67 / $770.35 / $3,104.06
| Professional | | $733.67 | $770.35 | $3,104.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.49 / $900.95 / $1,750.54
| Facility | | $786.49 | $900.95 | $1,750.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $934.70 / $1,226.40 / $1,523.61
| Professional | | $934.70 | $1,226.40 | $1,523.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $703.06 / $733.67 / $733.67
| Facility | | $703.06 | $733.67 | $733.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.67 / $733.67 / $733.67
| Professional | | $733.67 | $733.67 | $733.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.67 / $1,159.96 / $8,090.00
| Facility | | $733.67 | $1,159.96 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.67 / $733.67 / $733.67
| Professional | | $733.67 | $733.67 | $733.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.67 / $733.67 / $849.15
| Professional | | $733.67 | $733.67 | $849.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,043.05 / $2,039.26 / $8,284.09
| Facility | | $1,043.05 | $2,039.26 | $8,284.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.43 / $3,668.35 / $3,668.35
| Facility | | $1,146.43 | $3,668.35 | $3,668.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.67 / $777.69 / $3,104.06
| Professional | | $733.67 | $777.69 | $3,104.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.67 / $777.69 / $1,098.84
| Professional | | $733.67 | $777.69 | $1,098.84 |