- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $2,728.00 / $7,030.00
| Facility | | $1,017.00 | $2,728.00 | $7,030.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,017.00 / $2,004.10 / $5,393.00
| Professional | | $1,017.00 | $2,004.10 | $5,393.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,602.31 / $8,751.54 / $10,764.87
| Facility | | $7,602.31 | $8,751.54 | $10,764.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $587.00 / $908.00
| Facility | | $400.00 | $587.00 | $908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $200.00 / $345.40
| Professional | | $100.00 | $200.00 | $345.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.00 / $2,500.00 / $2,500.00
| Professional | | $1,500.00 | $2,500.00 | $2,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $5,820.00 / $12,241.00
| Facility | | $1,300.00 | $5,820.00 | $12,241.00 |