- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.00 / $600.00 / $600.00
| Facility | | $600.00 | $600.00 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.00 / $600.00 / $618.00
| Professional | | $600.00 | $600.00 | $618.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $856.30 / $3,508.51
| Facility | | $100.00 | $856.30 | $3,508.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.20 / $856.30 / $856.30
| Professional | | $466.20 | $856.30 | $856.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.95 / $960.68 / $1,219.20
| Facility | | $825.95 | $960.68 | $1,219.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.87 / $606.87 / $606.87
| Professional | | $606.87 | $606.87 | $606.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $1,150.00 / $1,200.00
| Facility | | $1,150.00 | $1,150.00 | $1,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.50 / $977.50 / $1,200.00
| Professional | | $839.50 | $977.50 | $1,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.63 / $642.23 / $856.30
| Professional | | $85.63 | $642.23 | $856.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.02 / $109.02 / $109.02
| Professional | | $109.02 | $109.02 | $109.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.26 / $84.26 / $84.26
| Facility | | $84.26 | $84.26 | $84.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $3,508.51
| Facility | | $100.00 | $100.00 | $3,508.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.72 / $416.31 / $466.20
| Professional | | $279.72 | $416.31 | $466.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.02 / $109.02 / $416.31
| Professional | | $109.02 | $109.02 | $416.31 |