- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.98 / $2,663.12 / $3,625.00
| Facility | | $299.98 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.46 / $328.62 / $646.49
| Professional | | $226.46 | $328.62 | $646.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $684.56 / $2,376.00 / $8,498.00
| Facility | | $684.56 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.70 / $598.74 / $2,037.20
| Professional | | $297.70 | $598.74 | $2,037.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.07 / $427.79 / $754.89
| Facility | | $329.07 | $427.79 | $754.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.89 / $632.12 / $1,013.48
| Professional | | $419.89 | $632.12 | $1,013.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.51 / $533.28 / $1,118.33
| Professional | | $319.51 | $533.28 | $1,118.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.69 / $600.02 / $6,679.00
| Facility | | $284.69 | $600.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.53 / $541.48 / $747.45
| Professional | | $430.53 | $541.48 | $747.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.93 / $727.96 / $1,150.59
| Professional | | $346.93 | $727.96 | $1,150.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,441.50 / $3,441.50 / $3,441.50
| Facility | | $3,441.50 | $3,441.50 | $3,441.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $16,394.00
| Facility | | $1,640.00 | $3,372.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.11 / $743.79 / $2,805.44
| Professional | | $421.11 | $743.79 | $2,805.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.92 / $542.26 / $1,050.09
| Professional | | $339.92 | $542.26 | $1,050.09 |