- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.00 / $1,133.16 / $1,881.22
| Facility | | $570.00 | $1,133.16 | $1,881.22 |
- 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
- $2,886.48 / $3,701.20 / $4,674.00
| Facility | | $2,886.48 | $3,701.20 | $4,674.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.26 / $336.26 / $512.55
| Professional | | $336.26 | $336.26 | $512.55 |
- 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 / $1,414.68 / $3,893.34
| Facility | | $494.00 | $1,414.68 | $3,893.34 |
- 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
- 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
- $604.20 / $760.00 / $1,292.00
| Facility | | $604.20 | $760.00 | $1,292.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,128.74 / $1,330.00 / $1,824.00
| Professional | | $1,128.74 | $1,330.00 | $1,824.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.00 / $843.45 / $1,411.02
| Facility | | $532.00 | $843.45 | $1,411.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.00 / $864.12 / $1,411.02
| Professional | | $532.00 | $864.12 | $1,411.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.20 / $380.00 / $874.00
| Professional | | $319.20 | $380.00 | $874.00 |