- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,479.11 / $3,467.37
| Facility | | $512.86 | $1,479.11 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $549.54 / $776.25
| Professional | | $457.09 | $549.54 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $2,691.53
| Facility | | $676.08 | $676.08 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $501.19
| Professional | | $281.84 | $281.84 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $3,801.89 / $5,623.41
| Professional | | $616.60 | $3,801.89 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,659.59 / $3,311.31
| Facility | | $691.83 | $1,659.59 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $436.52 / $1,202.26
| Professional | | $331.13 | $436.52 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $741.31 / $954.99
| Professional | | $676.08 | $741.31 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $933.25 / $1,380.38
| Facility | | $549.54 | $933.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,380.38 / $1,412.54
| Professional | | $457.09 | $1,380.38 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $891.25 / $10,000.00
| Facility | | $588.84 | $891.25 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $891.25 / $10,000.00
| Professional | | $602.56 | $891.25 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $812.83
| Facility | | $467.74 | $676.08 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $354.81 / $891.25
| Professional | | $281.84 | $354.81 | $891.25 |