- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.00 / $1,331.52 / $3,702.42
| Facility | | $456.00 | $1,331.52 | $3,702.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.60 / $501.60 / $646.00
| Professional | | $425.60 | $501.60 | $646.00 |
- 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
- $494.00 / $1,783.69 / $3,386.60
| Facility | | $494.00 | $1,783.69 | $3,386.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.90 / $925.90 / $1,109.33
| Professional | | $925.90 | $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
- $3,784.80 / $3,784.80 / $5,700.00
| Professional | | $3,784.80 | $3,784.80 | $5,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.00 / $760.00 / $1,112.35
| Facility | | $456.00 | $760.00 | $1,112.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.00 / $760.00 / $950.00
| Professional | | $760.00 | $760.00 | $950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.00 / $950.00 / $1,710.00
| Professional | | $684.00 | $950.00 | $1,710.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.93 / $782.50 / $2,736.97
| Facility | | $508.93 | $782.50 | $2,736.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.33 / $950.00 / $1,330.00
| Professional | | $718.33 | $950.00 | $1,330.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.20 / $319.20 / $456.00
| Professional | | $319.20 | $319.20 | $456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.26 / $336.26 / $760.00
| Professional | | $336.26 | $336.26 | $760.00 |