- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,768.11 / $9,175.45
| Facility | | $300.00 | $1,768.11 | $9,175.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $367.45 / $2,080.00
| Professional | | $275.42 | $367.45 | $2,080.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.66 / $453.66 / $1,209.00
| Professional | | $453.66 | $453.66 | $1,209.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.72 / $624.42 / $624.42
| Facility | | $580.72 | $624.42 | $624.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.42 / $624.42 / $624.42
| Professional | | $624.42 | $624.42 | $624.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $666.06 / $666.06 / $666.06
| Facility | | $666.06 | $666.06 | $666.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.15 / $566.15 / $666.06
| Professional | | $566.15 | $566.15 | $666.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $749.49 / $1,686.35
| Facility | | $319.00 | $749.49 | $1,686.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.20 / $562.12 / $1,365.57
| Professional | | $442.20 | $562.12 | $1,365.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.60 / $563.24 / $624.42
| Professional | | $450.60 | $563.24 | $624.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $1,190.25 / $1,325.00
| Facility | | $825.00 | $1,190.25 | $1,325.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $666.06 / $749.49
| Facility | | $597.00 | $666.06 | $749.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.22 / $566.15 / $1,161.71
| Professional | | $463.22 | $566.15 | $1,161.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.28 / $449.69 / $674.82
| Professional | | $249.28 | $449.69 | $674.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.60 / $450.60 / $468.25
| Facility | | $450.60 | $450.60 | $468.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.60 / $563.24 / $563.24
| Professional | | $450.60 | $563.24 | $563.24 |