- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.00 / $1,345.28 / $2,316.17
| Facility | | $532.00 | $1,345.28 | $2,316.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.70 / $532.00 / $562.40
| Professional | | $499.70 | $532.00 | $562.40 |
- 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
- $304.00 / $456.00 / $1,330.00
| Professional | | $304.00 | $456.00 | $1,330.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.52 / $531.05 / $1,729.00
| Facility | | $499.52 | $531.05 | $1,729.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $873.50 / $926.36 / $1,157.95
| Professional | | $873.50 | $926.36 | $1,157.95 |
- 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 / $1,770.80
| Professional | | $760.00 | $760.00 | $1,770.80 |
- 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
- $304.00 / $456.00 / $1,330.00
| Professional | | $304.00 | $456.00 | $1,330.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $684.00 / $760.00 / $912.00
| Facility | | $684.00 | $760.00 | $912.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.20 / $456.00 / $1,140.00
| Professional | | $319.20 | $456.00 | $1,140.00 |