- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.00 / $1,826.89 / $5,458.70
| Facility | | $570.00 | $1,826.89 | $5,458.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.20 / $630.79 / $646.00
| Professional | | $414.20 | $630.79 | $646.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $1,651.40 / $3,784.80
| Facility | | $988.00 | $1,651.40 | $3,784.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.12 / $422.71 / $1,322.40
| Professional | | $313.12 | $422.71 | $1,322.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $549.48 / $2,143.19
| Facility | | $92.60 | $549.48 | $2,143.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.80 / $494.00 / $1,241.86
| Professional | | $345.80 | $494.00 | $1,241.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.93 / $879.32 / $1,921.66
| Facility | | $508.93 | $879.32 | $1,921.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.00 / $596.00 / $596.00
| Professional | | $596.00 | $596.00 | $596.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.00 / $912.00 / $1,216.00
| Professional | | $760.00 | $912.00 | $1,216.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.00 / $874.00 / $1,451.60
| Professional | | $684.00 | $874.00 | $1,451.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.40 / $3,610.00 / $3,610.00
| Facility | | $1,322.40 | $3,610.00 | $3,610.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,800.00 / $3,800.00 / $5,700.00
| Professional | | $3,800.00 | $3,800.00 | $5,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.00 / $912.00 / $1,815.22
| Facility | | $608.00 | $912.00 | $1,815.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.00 / $836.00 / $1,094.40
| Professional | | $760.00 | $836.00 | $1,094.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.00 / $760.00 / $760.00
| Professional | | $760.00 | $760.00 | $760.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.20 / $322.24 / $1,525.32
| Professional | | $319.20 | $322.24 | $1,525.32 |