- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.54 / $628.20 / $628.20
| Facility | | $519.54 | $628.20 | $628.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.67 / $519.54 / $1,500.00
| Professional | | $450.67 | $519.54 | $1,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,000.00 / $3,562.24
| Facility | | $500.00 | $1,000.00 | $3,562.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.30 / $500.00 / $900.00
| Professional | | $6.30 | $500.00 | $900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,586.68 / $16,586.68 / $23,386.61
| Facility | | $16,586.68 | $16,586.68 | $23,386.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,749.62 / $36,749.62 / $36,749.62
| Professional | | $36,749.62 | $36,749.62 | $36,749.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.20 / $628.20 / $1,331.35
| Facility | | $628.20 | $628.20 | $1,331.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.45 / $136.81 / $660.00
| Professional | | $109.45 | $136.81 | $660.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.46 / $21.46 / $486.86
| Professional | | $21.46 | $21.46 | $486.86 |