- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $2,836.04 / $2,836.04
| Facility | | $30.00 | $2,836.04 | $2,836.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $41.00 / $1,067.00
| Professional | | $30.00 | $41.00 | $1,067.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.00 / $750.00 / $1,264.70
| Professional | | $450.00 | $750.00 | $1,264.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $1,950.00 / $3,000.00
| Facility | | $30.00 | $1,950.00 | $3,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.00 / $360.00 / $812.00
| Professional | | $360.00 | $360.00 | $812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.00 / $64.00 / $87.00
| Professional | | $44.00 | $64.00 | $87.00 |