- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.50 / $1,525.69 / $4,955.10
| Facility | | $562.50 | $1,525.69 | $4,955.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.75 / $562.50 / $637.50
| Professional | | $408.75 | $562.50 | $637.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $3,757.50
| Facility | | $244.00 | $614.00 | $3,757.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.26 / $373.24 / $672.52
| Professional | | $336.26 | $373.24 | $672.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.90 / $1,024.50 / $6,810.00
| Facility | | $59.90 | $1,024.50 | $6,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.25 / $487.50 / $718.72
| Professional | | $341.25 | $487.50 | $718.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.23 / $984.75 / $2,454.56
| Facility | | $502.23 | $984.75 | $2,454.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.93 / $1,077.41 / $1,142.46
| Professional | | $861.93 | $1,077.41 | $1,142.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.00 / $750.00 / $1,200.00
| Professional | | $99.00 | $750.00 | $1,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.00 / $750.00 / $1,312.50
| Professional | | $600.00 | $750.00 | $1,312.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.00 / $3,562.50 / $3,562.50
| Facility | | $1,305.00 | $3,562.50 | $3,562.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $20.00 / $20.00
| Professional | | $20.00 | $20.00 | $20.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.00 / $750.00 / $1,791.28
| Facility | | $450.00 | $750.00 | $1,791.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.00 / $750.00 / $750.00
| Professional | | $615.00 | $750.00 | $750.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.00 / $315.00 / $1,485.00
| Professional | | $315.00 | $315.00 | $1,485.00 |