- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.00 / $1,040.00 / $1,831.00
| Facility | | $1,040.00 | $1,040.00 | $1,831.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.52 / $115.80 / $309.38
| Professional | | $67.52 | $115.80 | $309.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.65 / $147.65 / $147.65
| Professional | | $147.65 | $147.65 | $147.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.87 / $124.44 / $204.31
| Professional | | $75.87 | $124.44 | $204.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $20.00 / $42.50
| Professional | | $17.00 | $20.00 | $42.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.00 / $1,236.00 / $5,253.00
| Facility | | $743.00 | $1,236.00 | $5,253.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.64 / $202.62 / $339.30
| Professional | | $95.64 | $202.62 | $339.30 |