- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.00 / $2,660.00 / $3,178.52
| Facility | | $646.00 | $2,660.00 | $3,178.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.00 / $615.60 / $646.00
| Professional | | $456.00 | $615.60 | $646.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.79 / $592.79 / $592.79
| Professional | | $592.79 | $592.79 | $592.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.82 / $988.00 / $2,522.01
| Facility | | $508.82 | $988.00 | $2,522.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,663.20 / $3,663.20 / $3,663.20
| Professional | | $3,663.20 | $3,663.20 | $3,663.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.00 / $1,026.00 / $1,877.20
| Professional | | $798.00 | $1,026.00 | $1,877.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.26 / $2,622.46 / $3,178.52
| Facility | | $846.26 | $2,622.46 | $3,178.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.79 / $646.00 / $3,138.80
| Professional | | $498.79 | $646.00 | $3,138.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.80 / $1,140.00 / $1,520.00
| Professional | | $1,124.80 | $1,140.00 | $1,520.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.82 / $988.00 / $2,522.01
| Facility | | $508.82 | $988.00 | $2,522.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,663.20 / $3,663.20 / $3,663.20
| Professional | | $3,663.20 | $3,663.20 | $3,663.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $760.00 / $760.00
| Facility | | $760.00 | $760.00 | $760.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.00 / $760.00 / $760.00
| Professional | | $760.00 | $760.00 | $760.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.20 / $456.00 / $1,014.75
| Professional | | $319.20 | $456.00 | $1,014.75 |