- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.95 / $605.20 / $2,072.00
| Facility | | $380.95 | $605.20 | $2,072.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.50 / $475.00 / $605.20
| Professional | | $370.50 | $475.00 | $605.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.51 / $941.10 / $3,446.24
| Facility | | $442.51 | $941.10 | $3,446.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.48 / $785.14 / $4,344.14
| Professional | | $451.48 | $785.14 | $4,344.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.76 / $1,239.08 / $2,085.62
| Facility | | $771.76 | $1,239.08 | $2,085.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.79 / $2,047.12 / $5,053.50
| Facility | | $274.79 | $2,047.12 | $5,053.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.90 / $854.86 / $1,389.88
| Professional | | $456.90 | $854.86 | $1,389.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.78 / $556.98 / $6,679.00
| Facility | | $251.78 | $556.98 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.34 / $375.95 / $704.76
| Professional | | $174.34 | $375.95 | $704.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.80 / $928.05 / $1,205.04
| Professional | | $460.80 | $928.05 | $1,205.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.47 / $3,446.24 / $3,446.24
| Facility | | $3,311.47 | $3,446.24 | $3,446.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.10 / $859.32 / $4,344.14
| Professional | | $453.10 | $859.32 | $4,344.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.48 / $720.76 / $1,207.19
| Professional | | $451.48 | $720.76 | $1,207.19 |