- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.00 / $1,480.44 / $2,792.40
| Facility | | $585.00 | $1,480.44 | $2,792.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.00 / $639.60 / $663.00
| Professional | | $585.00 | $639.60 | $663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $780.00 / $780.00 / $3,833.70
| Facility | | $780.00 | $780.00 | $3,833.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.00 / $312.00 / $507.00
| Professional | | $312.00 | $312.00 | $507.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $780.00 / $1,521.00 / $3,878.51
| Professional | | $780.00 | $1,521.00 | $3,878.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.00 / $1,328.63 / $3,535.96
| Facility | | $507.00 | $1,328.63 | $3,535.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.48 / $473.51 / $1,287.57
| Professional | | $384.48 | $473.51 | $1,287.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $780.00 / $936.00 / $1,154.40
| Professional | | $780.00 | $936.00 | $1,154.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $649.35 / $897.00 / $1,326.00
| Facility | | $649.35 | $897.00 | $1,326.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $780.00 / $1,092.00 / $1,872.00
| Professional | | $780.00 | $1,092.00 | $1,872.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.60 / $937.56 / $9,929.00
| Facility | | $639.60 | $937.56 | $9,929.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.60 / $937.56 / $9,929.00
| Professional | | $639.60 | $937.56 | $9,929.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.60 / $390.00 / $897.00
| Professional | | $327.60 | $390.00 | $897.00 |