- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.00 / $1,442.48 / $2,720.80
| Facility | | $570.00 | $1,442.48 | $2,720.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.00 / $623.20 / $646.00
| Professional | | $570.00 | $623.20 | $646.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $760.00 / $3,735.40
| Facility | | $760.00 | $760.00 | $3,735.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.00 / $304.00 / $494.00
| Professional | | $304.00 | $304.00 | $494.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.00 / $684.00 / $1,333.80
| Professional | | $608.00 | $684.00 | $1,333.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.00 / $1,675.25 / $3,893.34
| Facility | | $494.00 | $1,675.25 | $3,893.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.60 / $925.90 / $1,109.33
| Professional | | $444.60 | $925.90 | $1,109.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.00 / $912.00 / $1,124.80
| Professional | | $760.00 | $912.00 | $1,124.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.70 / $874.00 / $1,365.72
| Facility | | $632.70 | $874.00 | $1,365.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,041.00 / $1,330.00 / $1,824.00
| Professional | | $1,041.00 | $1,330.00 | $1,824.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.00 / $760.00 / $1,219.04
| Facility | | $532.00 | $760.00 | $1,219.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.00 / $760.00 / $1,219.04
| Professional | | $532.00 | $760.00 | $1,219.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.20 / $319.20 / $319.20
| Facility | | $319.20 | $319.20 | $319.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.20 / $380.00 / $874.00
| Professional | | $319.20 | $380.00 | $874.00 |