- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,776.00 / $5,866.00 / $16,467.00
| Facility | | $3,776.00 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.30 / $323.00 / $646.00
| Professional | | $81.30 | $323.00 | $646.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.83 / $294.10 / $462.31
| Facility | | $161.83 | $294.10 | $462.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $535.00 / $570.00
| Facility | | $100.00 | $535.00 | $570.00 |
- 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
- $101.00 / $1,138.00 / $2,922.00
| Facility | | $101.00 | $1,138.00 | $2,922.00 |