- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.00 / $1,710.00 / $2,316.17
| Facility | | $532.00 | $1,710.00 | $2,316.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.70 / $532.00 / $615.60
| Professional | | $499.70 | $532.00 | $615.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.40 / $3,610.00 / $3,610.00
| Facility | | $1,322.40 | $3,610.00 | $3,610.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.00 / $456.00 / $3,800.00
| Professional | | $456.00 | $456.00 | $3,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $1,086.80 / $1,900.00
| Facility | | $760.00 | $1,086.80 | $1,900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.00 / $646.00 / $646.00
| Professional | | $646.00 | $646.00 | $646.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.94 / $592.79 / $1,729.00
| Facility | | $498.94 | $592.79 | $1,729.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.71 / $840.71 / $1,007.27
| Professional | | $840.71 | $840.71 | $1,007.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.84 / $1,096.84 / $1,290.42
| Professional | | $1,096.84 | $1,096.84 | $1,290.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.00 / $760.00 / $1,578.37
| Professional | | $760.00 | $760.00 | $1,578.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.40 / $3,610.00 / $3,610.00
| Facility | | $1,322.40 | $3,610.00 | $3,610.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.00 / $456.00 / $3,800.00
| Professional | | $456.00 | $456.00 | $3,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.00 / $456.00 / $1,330.00
| Professional | | $456.00 | $456.00 | $1,330.00 |