- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.00 / $8,761.00 / $15,300.00
| Facility | | $390.00 | $8,761.00 | $15,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.00 / $408.00 / $540.00
| Professional | | $360.00 | $408.00 | $540.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.43 / $422.01 / $2,256.56
| Facility | | $301.43 | $422.01 | $2,256.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.09 / $731.09 / $875.93
| Professional | | $731.09 | $731.09 | $875.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.00 / $360.00 / $510.00
| Professional | | $360.00 | $360.00 | $510.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.00 / $600.00 / $900.00
| Facility | | $600.00 | $600.00 | $900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.00 / $252.00 / $940.12
| Professional | | $210.00 | $252.00 | $940.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.00 / $360.00 / $360.00
| Professional | | $360.00 | $360.00 | $360.00 |