- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.00 / $495.00 / $530.24
| Facility | | $495.00 | $495.00 | $530.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.00 / $495.00 / $495.00
| Professional | | $495.00 | $495.00 | $495.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.95 / $58.64 / $114.35
| Facility | | $44.95 | $58.64 | $114.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.00 / $1,140.00 / $1,230.00
| Professional | | $570.00 | $1,140.00 | $1,230.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.93 / $1,362.39 / $1,702.99
| Professional | | $861.93 | $1,362.39 | $1,702.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.00 / $891.00 / $3,562.50
| Facility | | $450.00 | $891.00 | $3,562.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.00 / $450.00 / $1,500.00
| Professional | | $450.00 | $450.00 | $1,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $1,312.50 / $1,545.00
| Facility | | $900.00 | $1,312.50 | $1,545.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.75 / $1,377.75 / $1,643.69
| Professional | | $900.75 | $1,377.75 | $1,643.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.50 / $450.00 / $825.00
| Professional | | $427.50 | $450.00 | $825.00 |