- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $436.52
| Facility | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $436.52 / $1,000.00
| Professional | | $323.59 | $436.52 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,023.29 / $4,786.30
| Facility | | $891.25 | $1,023.29 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $676.08 / $1,023.29
| Professional | | $389.05 | $676.08 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $1,737.80
| Facility | | $575.44 | $575.44 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $891.25 / $891.25
| Professional | | $724.44 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $707.95
| Facility | | $489.78 | $575.44 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $512.86
| Professional | | $354.81 | $354.81 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $1,318.26
| Professional | | $870.96 | $870.96 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Professional | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,023.29 / $4,786.30
| Facility | | $891.25 | $1,023.29 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $724.44 / $1,122.02
| Professional | | $389.05 | $724.44 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.60 / $562.34 / $1,023.29
| Facility | | $0.60 | $562.34 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $562.34 / $870.96
| Professional | | $380.19 | $562.34 | $870.96 |