- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,684.00 / $18,600.00
| Facility | | $1,000.00 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.68 / $45.84 / $74.78
| Professional | | $45.68 | $45.84 | $74.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.68 / $100.21 / $1,470.67
| Facility | | $45.68 | $100.21 | $1,470.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.05 / $14.34 / $204.47
| Professional | | $11.05 | $14.34 | $204.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $610.00 / $1,883.00
| Facility | | $100.00 | $610.00 | $1,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $13.65 / $104.33
| Professional | | $10.40 | $13.65 | $104.33 |