- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $419.44 / $1,380.00 / $2,187.08
| Facility | | $419.44 | $1,380.00 | $2,187.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.13 / $419.44 / $705.42
| Professional | | $397.13 | $419.44 | $705.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.32 / $686.13 / $1,878.60
| Facility | | $443.32 | $686.13 | $1,878.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.00 / $600.70 / $2,379.38
| Professional | | $360.00 | $600.70 | $2,379.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.77 / $1,363.89 / $2,384.42
| Facility | | $953.77 | $1,363.89 | $2,384.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.25 / $563.25 / $563.25
| Professional | | $563.25 | $563.25 | $563.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.00 / $733.20 / $1,365.00
| Facility | | $390.00 | $733.20 | $1,365.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.65 / $576.14 / $1,564.33
| Professional | | $353.65 | $576.14 | $1,564.33 |
- 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
- $865.82 / $865.82 / $1,018.61
| Professional | | $865.82 | $865.82 | $1,018.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.00 / $600.00 / $1,858.14
| Professional | | $600.00 | $600.00 | $1,858.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.00 / $2,850.00 / $2,850.00
| Facility | | $1,044.00 | $2,850.00 | $2,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.00 / $360.42 / $3,000.00
| Professional | | $360.00 | $360.42 | $3,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.00 / $360.42 / $1,262.08
| Professional | | $360.00 | $360.42 | $1,262.08 |