- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.47 / $294.10 / $462.31
| Facility | | $153.47 | $294.10 | $462.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $890.00
| Facility | | $890.00 | $890.00 | $890.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $120.00 / $2,117.16
| Professional | | $100.00 | $120.00 | $2,117.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $1,221.00 / $3,585.00
| Facility | | $225.00 | $1,221.00 | $3,585.00 |