- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.00 / $1,331.52 / $3,702.42
| Facility | | $456.00 | $1,331.52 | $3,702.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.60 / $501.60 / $615.60
| Professional | | $425.60 | $501.60 | $615.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.00 / $760.00 / $760.00
| Professional | | $760.00 | $760.00 | $760.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.18 / $1,783.69 / $4,029.26
| Facility | | $500.18 | $1,783.69 | $4,029.26 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $1,216.00 / $3,610.00 / $3,610.00
| Facility | | $1,216.00 | $3,610.00 | $3,610.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,784.80 / $3,784.80 / $5,700.00
| Professional | | $3,784.80 | $3,784.80 | $5,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.00 / $760.00 / $1,132.40
| Facility | | $456.00 | $760.00 | $1,132.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.00 / $760.00 / $950.00
| Professional | | $760.00 | $760.00 | $950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.00 / $950.00 / $1,710.00
| Professional | | $684.00 | $950.00 | $1,710.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.19 / $1,906.06 / $4,094.42
| Facility | | $525.19 | $1,906.06 | $4,094.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.33 / $836.00 / $1,330.00
| Professional | | $718.33 | $836.00 | $1,330.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.20 / $319.20 / $540.00
| Professional | | $319.20 | $319.20 | $540.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.00 / $304.00 / $760.00
| Professional | | $304.00 | $304.00 | $760.00 |