- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $1,008.00 / $2,052.00
| Facility | | $594.00 | $1,008.00 | $2,052.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.70 / $558.00 / $675.90
| Professional | | $385.70 | $558.00 | $675.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.40 / $1,008.00 / $1,274.40
| Facility | | $842.40 | $1,008.00 | $1,274.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.91 / $1,728.00 / $3,722.40
| Facility | | $53.91 | $1,728.00 | $3,722.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.58 / $1,056.59 / $2,808.00
| Facility | | $247.58 | $1,056.59 | $2,808.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $520.55 / $2,030.40
| Facility | | $92.60 | $520.55 | $2,030.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.00 / $432.00 / $629.34
| Professional | | $432.00 | $432.00 | $629.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.90 / $228.90 / $670.44
| Professional | | $228.90 | $228.90 | $670.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.00 / $720.00 / $720.00
| Professional | | $720.00 | $720.00 | $720.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.60 / $468.00 / $1,176.51
| Professional | | $327.60 | $468.00 | $1,176.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.00 / $720.00 / $1,094.40
| Professional | | $720.00 | $720.00 | $1,094.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.00 / $1,216.80 / $2,159.82
| Facility | | $585.00 | $1,216.80 | $2,159.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.62 / $876.87 / $1,050.58
| Professional | | $773.62 | $876.87 | $1,050.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.00 / $720.00 / $720.00
| Facility | | $720.00 | $720.00 | $720.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.39 / $432.00 / $936.00
| Professional | | $302.39 | $432.00 | $936.00 |