- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.22 / $571.22 / $571.22
| Facility | | $571.22 | $571.22 | $571.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.22 / $571.22 / $956.15
| Professional | | $571.22 | $571.22 | $956.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,169.72 / $3,689.30 / $5,814.95
| Facility | | $1,169.72 | $3,689.30 | $5,814.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.98 / $942.70 / $1,276.73
| Professional | | $565.98 | $942.70 | $1,276.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.64 / $1,688.22 / $2,174.11
| Facility | | $1,387.64 | $1,688.22 | $2,174.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $941.68 / $1,098.95 / $1,098.95
| Professional | | $941.68 | $1,098.95 | $1,098.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.20 / $895.43 / $916.54
| Facility | | $756.20 | $895.43 | $916.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.66 / $895.43 / $1,604.63
| Professional | | $653.66 | $895.43 | $1,604.63 |
- 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
- $1,058.53 / $1,058.53 / $1,111.46
| Professional | | $1,058.53 | $1,058.53 | $1,111.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.30 / $986.30 / $986.30
| Professional | | $986.30 | $986.30 | $986.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,809.97 / $5,814.95 / $5,814.95
| Facility | | $2,809.97 | $5,814.95 | $5,814.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.69 / $698.83 / $1,276.73
| Professional | | $510.69 | $698.83 | $1,276.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.23 / $698.83 / $1,251.57
| Professional | | $556.23 | $698.83 | $1,251.57 |