- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.95 / $2,079.00 / $3,625.00
| Facility | | $355.95 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.77 / $383.47 / $626.70
| Professional | | $328.77 | $383.47 | $626.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.01 / $947.00 / $3,445.00
| Facility | | $464.01 | $947.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.70 / $741.33 / $2,918.16
| Professional | | $358.70 | $741.33 | $2,918.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.54 / $580.23 / $1,035.83
| Facility | | $451.54 | $580.23 | $1,035.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.45 / $643.30 / $1,115.58
| Professional | | $398.45 | $643.30 | $1,115.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.95 / $823.32 / $6,679.00
| Facility | | $376.95 | $823.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.18 / $570.78 / $787.90
| Professional | | $469.18 | $570.78 | $787.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.90 / $925.50 / $1,199.08
| Professional | | $464.90 | $925.50 | $1,199.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,926.98 / $12,000.00
| Facility | | $627.00 | $1,926.98 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.96 / $789.31 / $2,918.16
| Professional | | $400.96 | $789.31 | $2,918.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.58 / $584.08 / $1,215.32
| Professional | | $397.58 | $584.08 | $1,215.32 |