- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $1,659.59
| Facility | | $416.87 | $416.87 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $489.78 / $977.24
| Professional | | $398.11 | $489.78 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $933.25 / $4,570.88
| Facility | | $912.01 | $933.25 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $741.31 / $1,000.00
| Professional | | $398.11 | $741.31 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,258.93 / $1,659.59
| Facility | | $1,071.52 | $1,258.93 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $741.31 / $741.31
| Professional | | $562.34 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $562.34
| Professional | | $398.11 | $398.11 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $1,288.25
| Professional | | $851.14 | $851.14 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Professional | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $933.25 / $4,570.88
| Facility | | $912.01 | $933.25 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $741.31 / $1,096.48
| Professional | | $398.11 | $741.31 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.71 / $512.86 / $1,202.26
| Facility | | $0.71 | $512.86 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $562.34 / $851.14
| Professional | | $380.19 | $562.34 | $851.14 |