- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.80 / $2,242.08 / $4,723.20
| Facility | | $676.80 | $2,242.08 | $4,723.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.00 / $676.80 / $698.40
| Professional | | $504.00 | $676.80 | $698.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $1,152.00 / $2,520.00
| Facility | | $756.00 | $1,152.00 | $2,520.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.00 / $1,496.80 / $5,400.00
| Professional | | $648.00 | $1,496.80 | $5,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.80 / $1,530.50 / $1,859.13
| Facility | | $748.80 | $1,530.50 | $1,859.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.00 / $720.00 / $1,800.00
| Facility | | $648.00 | $720.00 | $1,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.00 / $720.00 / $1,800.00
| Professional | | $648.00 | $720.00 | $1,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $75.00
| Professional | | $75.00 | $75.00 | $75.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.00 / $720.00 / $1,008.00
| Facility | | $720.00 | $720.00 | $1,008.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.00 / $1,260.00 / $2,160.00
| Facility | | $720.00 | $1,260.00 | $2,160.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.00 / $900.00 / $1,087.20
| Professional | | $648.00 | $900.00 | $1,087.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $1,152.00 / $1,980.00
| Facility | | $756.00 | $1,152.00 | $1,980.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.32 / $1,328.98 / $1,763.75
| Professional | | $796.32 | $1,328.98 | $1,763.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.39 / $302.39 / $792.00
| Professional | | $302.39 | $302.39 | $792.00 |