- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.00 / $646.00 / $1,881.22
| Facility | | $570.00 | $646.00 | $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
- $168.13 / $168.13 / $285.31
| Professional | | $168.13 | $168.13 | $285.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.00 / $608.00 / $1,185.59
| Professional | | $608.00 | $608.00 | $1,185.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.00 / $1,675.25 / $3,893.34
| Facility | | $494.00 | $1,675.25 | $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
- $570.00 / $760.00 / $1,292.00
| Facility | | $570.00 | $760.00 | $1,292.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $897.00 / $1,330.00 / $1,824.00
| Professional | | $897.00 | $1,330.00 | $1,824.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.72 / $874.00 / $1,411.02
| Facility | | $567.72 | $874.00 | $1,411.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.72 / $874.00 / $1,411.02
| Professional | | $567.72 | $874.00 | $1,411.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $684.00 / $760.00 / $1,140.00
| Facility | | $684.00 | $760.00 | $1,140.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.20 / $395.20 / $988.00
| Professional | | $319.20 | $395.20 | $988.00 |