- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.95 / $3,839.00 / $7,347.75
| Facility | | $278.95 | $3,839.00 | $7,347.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.55 / $284.35 / $692.34
| Professional | | $232.55 | $284.35 | $692.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,800.00 / $7,463.00 / $11,048.00
| Facility | | $2,800.00 | $7,463.00 | $11,048.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.95 / $271.83 / $271.83
| Professional | | $261.95 | $271.83 | $271.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.47 / $342.49 / $538.54
| Professional | | $252.47 | $342.49 | $538.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.74 / $401.75 / $402.29
| Professional | | $303.74 | $401.75 | $402.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,442.80 / $4,101.13 / $12,763.67
| Facility | | $3,442.80 | $4,101.13 | $12,763.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $3,839.00 / $7,799.00
| Facility | | $657.00 | $3,839.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.55 / $314.27 / $1,037.00
| Professional | | $232.55 | $314.27 | $1,037.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $525.00 / $650.00
| Professional | | $3.00 | $525.00 | $650.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.48 / $342.49 / $593.30
| Professional | | $259.48 | $342.49 | $593.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.55 / $254.55 / $681.93
| Facility | | $254.55 | $254.55 | $681.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.49 / $256.18 / $681.93
| Professional | | $246.49 | $256.18 | $681.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.89 / $339.70 / $539.40
| Professional | | $266.89 | $339.70 | $539.40 |