- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.33 / $638.61 / $2,072.00
| Facility | | $361.33 | $638.61 | $2,072.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.96 / $475.00 / $638.61
| Professional | | $358.96 | $475.00 | $638.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.89 / $1,221.71 / $3,244.96
| Facility | | $465.89 | $1,221.71 | $3,244.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.11 / $634.16 / $2,899.34
| Professional | | $415.11 | $634.16 | $2,899.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $897.21 / $1,444.30 / $2,431.03
| Facility | | $897.21 | $1,444.30 | $2,431.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.28 / $404.28 / $404.28
| Professional | | $404.28 | $404.28 | $404.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.38 / $866.41 / $2,335.44
| Facility | | $455.38 | $866.41 | $2,335.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.78 / $713.51 / $1,256.99
| Professional | | $409.78 | $713.51 | $1,256.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,472.00 / $9,239.00
| Facility | | $83.43 | $3,472.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.67 / $424.74 / $578.13
| Professional | | $66.67 | $424.74 | $578.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.40 / $868.36 / $1,138.60
| Professional | | $435.40 | $868.36 | $1,138.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,584.08 / $3,244.96 / $3,244.96
| Facility | | $2,584.08 | $3,244.96 | $3,244.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.35 / $634.16 / $2,899.34
| Professional | | $432.35 | $634.16 | $2,899.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.00 / $589.60 / $1,090.46
| Professional | | $431.00 | $589.60 | $1,090.46 |