- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $676.08 / $2,137.96
| Facility | | $281.84 | $676.08 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $354.81 / $467.74
| Professional | | $281.84 | $354.81 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $660.69 / $2,089.30
| Facility | | $302.00 | $660.69 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $676.08
| Professional | | $562.34 | $562.34 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,467.37 / $3,467.37
| Professional | | $2,344.23 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $467.74 / $870.96
| Facility | | $354.81 | $467.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $371.54 / $588.84
| Professional | | $281.84 | $371.54 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $501.19 / $1,000.00
| Professional | | $467.74 | $501.19 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $467.74 / $1,288.25
| Facility | | $323.59 | $467.74 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $512.86 / $812.83
| Professional | | $416.87 | $512.86 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $194.98 / $467.74
| Facility | | $165.96 | $194.98 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $323.59
| Professional | | $194.98 | $194.98 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $467.74 / $467.74
| Professional | | $181.97 | $467.74 | $467.74 |