- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $2,536.00 / $7,500.00
| Facility | | $500.00 | $2,536.00 | $7,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.83 / $57.78 / $58.98
| Professional | | $24.83 | $57.78 | $58.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,926.95 / $3,005.44 / $4,713.87
| Facility | | $1,926.95 | $3,005.44 | $4,713.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.65 / $57.05 / $78.34
| Professional | | $27.65 | $57.05 | $78.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.71 / $60.35 / $84.75
| Professional | | $28.71 | $60.35 | $84.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.78 / $61.93 / $1,541.00
| Facility | | $25.78 | $61.93 | $1,541.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.52 / $65.17 / $209.46
| Professional | | $51.52 | $65.17 | $209.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $610.00 / $1,883.00
| Facility | | $100.00 | $610.00 | $1,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.66 / $62.07 / $89.96
| Professional | | $49.66 | $62.07 | $89.96 |