- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.00 / $1,424.44 / $1,584.75
| Facility | | $364.00 | $1,424.44 | $1,584.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.80 / $384.80 / $800.80
| Professional | | $345.80 | $384.80 | $800.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.76 / $1,446.36 / $1,899.92
| Facility | | $607.76 | $1,446.36 | $1,899.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.00 / $520.00 / $2,062.13
| Professional | | $312.00 | $520.00 | $2,062.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.60 / $1,182.04 / $2,066.50
| Facility | | $826.60 | $1,182.04 | $2,066.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.40 / $478.40 / $478.40
| Professional | | $478.40 | $478.40 | $478.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.38 / $405.60 / $1,183.00
| Facility | | $341.38 | $405.60 | $1,183.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.10 / $548.75 / $2,320.64
| Professional | | $312.10 | $548.75 | $2,320.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.53 / $750.53 / $882.98
| Professional | | $750.53 | $750.53 | $882.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.00 / $520.00 / $1,610.39
| Professional | | $520.00 | $520.00 | $1,610.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $904.80 / $2,470.00 / $2,470.00
| Facility | | $904.80 | $2,470.00 | $2,470.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.00 / $312.00 / $2,600.00
| Professional | | $312.00 | $312.00 | $2,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.00 / $312.00 / $928.75
| Professional | | $312.00 | $312.00 | $928.75 |