- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.50 / $615.00 / $3,336.00
| Facility | | $592.50 | $615.00 | $3,336.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.00 / $600.00 / $750.00
| Professional | | $525.00 | $600.00 | $750.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.07 / $336.26 / $336.26
| Professional | | $200.07 | $336.26 | $336.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $9,843.75 / $23,682.61
| Facility | | $900.00 | $9,843.75 | $23,682.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $862.50 / $1,050.00 / $13,913.53
| Professional | | $862.50 | $1,050.00 | $13,913.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.50 / $583.58 / $989.63
| Facility | | $487.50 | $583.58 | $989.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.55 / $3,615.00 / $3,615.00
| Professional | | $870.55 | $3,615.00 | $3,615.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $100.00 / $100.00
| Professional | | $45.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.50 / $450.00 / $825.00
| Professional | | $337.50 | $450.00 | $825.00 |