- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.85 / $1,823.00 / $3,363.00
| Facility | | $299.85 | $1,823.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.05 / $369.59 / $611.49
| Professional | | $273.05 | $369.59 | $611.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $1,027.76 / $12,000.00
| Facility | | $308.00 | $1,027.76 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.76 / $726.68 / $3,071.92
| Professional | | $340.76 | $726.68 | $3,071.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.62 / $444.12 / $792.16
| Facility | | $345.62 | $444.12 | $792.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.74 / $353.73 / $353.73
| Professional | | $204.74 | $353.73 | $353.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $482.73 / $607.77
| Facility | | $443.00 | $482.73 | $607.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.83 / $605.82 / $1,215.96
| Professional | | $326.83 | $605.82 | $1,215.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.37 / $630.20 / $6,679.00
| Facility | | $296.37 | $630.20 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.52 / $636.57 / $914.22
| Professional | | $492.52 | $636.57 | $914.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.94 / $785.89 / $1,158.58
| Professional | | $421.94 | $785.89 | $1,158.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $1,992.72 / $12,000.00
| Facility | | $308.00 | $1,992.72 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.95 / $1,004.31 / $3,071.92
| Professional | | $442.95 | $1,004.31 | $3,071.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $1,078.00 / $2,733.00
| Facility | | $308.00 | $1,078.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.21 / $624.91 / $1,452.78
| Professional | | $410.21 | $624.91 | $1,452.78 |