- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $2,344.23
| Facility | | $407.38 | $407.38 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $562.34 / $2,137.96
| Professional | | $389.05 | $562.34 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,148.15 / $5,623.41
| Facility | | $630.96 | $1,148.15 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $645.65 / $3,388.44
| Professional | | $426.58 | $645.65 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $724.44 / $1,778.28
| Facility | | $588.84 | $724.44 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $912.01 / $2,511.89
| Facility | | $416.87 | $912.01 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $954.99 / $1,659.59
| Professional | | $549.54 | $954.99 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $478.63 / $8,511.38
| Facility | | $269.15 | $478.63 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $512.86 / $1,000.00
| Professional | | $354.81 | $512.86 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $912.01 / $1,513.56
| Professional | | $575.44 | $912.01 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,148.15 / $5,623.41
| Facility | | $630.96 | $1,148.15 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $645.65 / $3,388.44
| Professional | | $426.58 | $645.65 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,000.00 / $1,819.70
| Facility | | $288.40 | $1,000.00 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $724.44 / $1,584.89
| Professional | | $478.63 | $724.44 | $1,584.89 |