- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.60 / $1,331.52 / $3,731.60
| Facility | | $501.60 | $1,331.52 | $3,731.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.60 / $501.60 / $646.00
| Professional | | $425.60 | $501.60 | $646.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.00 / $760.00 / $760.00
| Professional | | $646.00 | $760.00 | $760.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.26 / $1,744.15 / $3,386.60
| Facility | | $506.26 | $1,744.15 | $3,386.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.80 / $925.90 / $1,109.33
| Professional | | $402.80 | $925.90 | $1,109.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.00 / $3,610.00 / $3,610.00
| Facility | | $1,216.00 | $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
- $456.00 / $760.00 / $1,069.29
| Facility | | $456.00 | $760.00 | $1,069.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.00 / $760.00 / $950.00
| Professional | | $722.00 | $760.00 | $950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.00 / $950.00 / $2,660.00
| Professional | | $494.00 | $950.00 | $2,660.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.57 / $1,744.15 / $4,029.26
| Facility | | $531.57 | $1,744.15 | $4,029.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.00 / $919.60 / $1,330.00
| Professional | | $608.00 | $919.60 | $1,330.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.20 / $319.20 / $542.64
| Professional | | $319.20 | $319.20 | $542.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.33 / $325.33 / $760.00
| Professional | | $325.33 | $325.33 | $760.00 |