- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,140.00 / $3,140.00 / $6,907.00
| Facility | | $3,140.00 | $3,140.00 | $6,907.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.76 / $145.63 / $230.68
| Professional | | $102.76 | $145.63 | $230.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.01 / $110.01 / $2,151.00
| Facility | | $110.01 | $110.01 | $2,151.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.20 / $157.29 / $259.81
| Professional | | $106.20 | $157.29 | $259.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.00 / $440.00 / $5,000.00
| Facility | | $250.00 | $440.00 | $5,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.74 / $166.94 / $362.30
| Professional | | $131.74 | $166.94 | $362.30 |