- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,691.53 / $9,772.37
| Facility | | $630.96 | $2,691.53 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,023.29 / $3,715.35
| Professional | | $363.08 | $1,023.29 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $446.68 / $1,047.13
| Professional | | $363.08 | $446.68 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $5,495.41 / $8,128.31
| Facility | | $4,897.79 | $5,495.41 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $954.99 / $2,137.96
| Professional | | $302.00 | $954.99 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,737.80 / $3,162.28
| Professional | | $676.08 | $1,737.80 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,047.13 / $2,570.40
| Professional | | $363.08 | $1,047.13 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,479.11 / $3,630.78
| Professional | | $478.63 | $1,479.11 | $3,630.78 |