- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.50 / $1,488.00 / $4,366.01
| Facility | | $370.50 | $1,488.00 | $4,366.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.75 / $375.00 / $525.00
| Professional | | $318.75 | $375.00 | $525.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $671.75
| Professional | | $0.02 | $0.03 | $671.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.94 / $871.87 / $1,373.42
| Facility | | $720.94 | $871.87 | $1,373.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,338.15 / $1,338.15 / $1,338.15
| Professional | | $1,338.15 | $1,338.15 | $1,338.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.00 / $260.00 / $260.00
| Professional | | $260.00 | $260.00 | $260.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.64 / $478.64 / $2,020.00
| Facility | | $478.64 | $478.64 | $2,020.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $633.91 / $871.87 / $1,445.38
| Facility | | $633.91 | $871.87 | $1,445.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,338.15 / $1,338.15 / $1,338.15
| Professional | | $1,338.15 | $1,338.15 | $1,338.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.06 / $727.06 / $727.06
| Facility | | $727.06 | $727.06 | $727.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $727.06 / $727.06 / $727.06
| Professional | | $727.06 | $727.06 | $727.06 |