- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $2,484.42 / $2,973.60
| Facility | | $612.00 | $2,484.42 | $2,973.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.60 / $292.60 / $612.00
| Professional | | $292.60 | $292.60 | $612.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.60 / $561.60 / $561.60
| Professional | | $561.60 | $561.60 | $561.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.04 / $936.00 / $2,389.44
| Facility | | $482.04 | $936.00 | $2,389.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,470.40 / $3,470.40 / $3,470.40
| Professional | | $3,470.40 | $3,470.40 | $3,470.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.00 / $972.00 / $1,778.40
| Professional | | $756.00 | $972.00 | $1,778.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.69 / $391.69 / $1,068.83
| Facility | | $391.69 | $391.69 | $1,068.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.61 / $2,484.42 / $2,973.60
| Facility | | $608.61 | $2,484.42 | $2,973.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.60 / $828.00 / $2,973.60
| Professional | | $292.60 | $828.00 | $2,973.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,065.59 / $1,080.00 / $1,440.00
| Professional | | $1,065.59 | $1,080.00 | $1,440.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.04 / $936.00 / $2,389.44
| Facility | | $482.04 | $936.00 | $2,389.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,470.40 / $3,470.40 / $3,470.40
| Professional | | $3,470.40 | $3,470.40 | $3,470.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.00 / $720.00 / $792.00
| Facility | | $720.00 | $720.00 | $792.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.00 / $720.00 / $792.00
| Professional | | $720.00 | $720.00 | $792.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.39 / $432.00 / $1,303.49
| Professional | | $302.39 | $432.00 | $1,303.49 |