- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.60 / $1,620.00 / $2,194.27
| Facility | | $292.60 | $1,620.00 | $2,194.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.60 / $292.60 / $478.80
| Professional | | $292.60 | $292.60 | $478.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.00 / $1,836.73 / $2,630.66
| Facility | | $792.00 | $1,836.73 | $2,630.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.00 / $720.00 / $2,855.25
| Professional | | $432.00 | $720.00 | $2,855.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.00 / $1,029.59 / $1,800.00
| Facility | | $720.00 | $1,029.59 | $1,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.00 / $612.00 / $612.00
| Professional | | $612.00 | $612.00 | $612.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.68 / $561.60 / $1,638.00
| Facility | | $472.68 | $561.60 | $1,638.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.20 / $876.87 / $1,050.58
| Professional | | $421.20 | $876.87 | $1,050.58 |
- 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
- $1,038.99 / $1,038.99 / $1,222.33
| Professional | | $1,038.99 | $1,038.99 | $1,222.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.00 / $720.00 / $2,229.77
| Professional | | $720.00 | $720.00 | $2,229.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.80 / $3,420.00 / $3,420.00
| Facility | | $1,252.80 | $3,420.00 | $3,420.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.00 / $432.00 / $3,600.00
| Professional | | $432.00 | $432.00 | $3,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.00 / $432.00 / $1,285.96
| Professional | | $432.00 | $432.00 | $1,285.96 |