- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $573.92 / $943.75 / $2,261.00
| Facility | | $573.92 | $943.75 | $2,261.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.96 / $438.42 / $651.17
| Professional | | $351.96 | $438.42 | $651.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.72 / $1,494.41 / $3,029.20
| Facility | | $339.72 | $1,494.41 | $3,029.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.16 / $650.80 / $3,166.97
| Professional | | $407.16 | $650.80 | $3,166.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $823.87 / $1,193.86 / $2,023.77
| Facility | | $823.87 | $1,193.86 | $2,023.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.00 / $2,179.08 / $2,998.41
| Facility | | $387.00 | $2,179.08 | $2,998.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.30 / $670.89 / $1,300.38
| Professional | | $358.30 | $670.89 | $1,300.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.24 / $582.32 / $6,679.00
| Facility | | $263.24 | $582.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.09 / $371.97 / $622.75
| Professional | | $102.09 | $371.97 | $622.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.91 / $817.50 / $1,061.50
| Professional | | $405.91 | $817.50 | $1,061.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,408.40 / $3,029.20 / $3,029.20
| Facility | | $2,408.40 | $3,029.20 | $3,029.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.16 / $657.80 / $3,166.97
| Professional | | $407.16 | $657.80 | $3,166.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.68 / $561.60 / $989.75
| Professional | | $401.68 | $561.60 | $989.75 |