- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $1,831.00 / $2,825.00
| Facility | | $900.00 | $1,831.00 | $2,825.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,346.69 / $1,770.65 / $2,520.06
| Professional | | $1,346.69 | $1,770.65 | $2,520.06 |
- 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 / $20.00 / $25.00
| Professional | | $17.00 | $20.00 | $25.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $1,236.00 / $5,253.00
| Facility | | $624.00 | $1,236.00 | $5,253.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,957.14 / $2,417.65 / $5,637.00
| Professional | | $1,957.14 | $2,417.65 | $5,637.00 |