- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.00 / $1,331.52 / $3,731.60
| Facility | | $456.00 | $1,331.52 | $3,731.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.60 / $501.60 / $646.00
| Professional | | $425.60 | $501.60 | $646.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $402.80 / $676.40
| Professional | | $5.00 | $402.80 | $676.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.77 / $1,783.69 / $4,029.26
| Facility | | $489.77 | $1,783.69 | $4,029.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.80 / $840.71 / $1,007.27
| Professional | | $402.80 | $840.71 | $1,007.27 |
- 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
- $3,800.00 / $3,800.00 / $5,700.00
| Professional | | $3,800.00 | $3,800.00 | $5,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.00 / $760.00 / $1,064.53
| Facility | | $456.00 | $760.00 | $1,064.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.00 / $760.00 / $950.00
| Professional | | $722.00 | $760.00 | $950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.00 / $950.00 / $2,660.00
| Professional | | $494.00 | $950.00 | $2,660.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.22 / $1,744.15 / $4,094.42
| Facility | | $518.22 | $1,744.15 | $4,094.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.00 / $836.00 / $1,094.40
| Professional | | $684.00 | $836.00 | $1,094.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $760.00 / $950.00
| Facility | | $760.00 | $760.00 | $950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.20 / $319.20 / $468.16
| Professional | | $319.20 | $319.20 | $468.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.00 / $296.39 / $760.00
| Professional | | $200.00 | $296.39 | $760.00 |