- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.60 / $380.00 / $1,690.24
| Facility | | $311.60 | $380.00 | $1,690.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.60 / $380.00 / $380.00
| Professional | | $311.60 | $380.00 | $380.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.55 / $342.00 / $399.38
| Facility | | $236.55 | $342.00 | $399.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.00 / $1,246.40 / $1,246.40
| Professional | | $800.00 | $1,246.40 | $1,246.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.00 / $4,987.50 / $11,999.52
| Facility | | $456.00 | $4,987.50 | $11,999.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.00 / $532.00 / $7,049.72
| Professional | | $437.00 | $532.00 | $7,049.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.00 / $295.68 / $501.41
| Facility | | $247.00 | $295.68 | $501.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.32 / $1,831.60 / $1,831.60
| Professional | | $441.32 | $1,831.60 | $1,831.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.60 / $228.00 / $380.00
| Professional | | $159.60 | $228.00 | $380.00 |