- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.04 / $936.00 / $2,010.00
| Facility | | $301.04 | $936.00 | $2,010.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.74 / $264.91 / $382.32
| Professional | | $213.74 | $264.91 | $382.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.87 / $455.87 / $455.87
| Professional | | $455.87 | $455.87 | $455.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $25.00 / $50.00
| Professional | | $17.00 | $25.00 | $50.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.00 / $1,223.00 / $4,093.00
| Facility | | $690.00 | $1,223.00 | $4,093.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.29 / $417.44 / $861.62
| Professional | | $311.29 | $417.44 | $861.62 |