- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,562.00 / $4,050.00
| Facility | | $900.00 | $2,562.00 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,379.28 / $2,423.06 / $2,571.41
| Professional | | $1,379.28 | $2,423.06 | $2,571.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $0.03
| Facility | | $0.02 | $0.03 | $0.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,053.51 / $2,153.11 / $2,734.93
| Professional | | $2,053.51 | $2,153.11 | $2,734.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,309.00 / $7,168.00
| Facility | | $385.00 | $1,309.00 | $7,168.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,271.48 / $1,901.33 / $3,206.41
| Professional | | $1,271.48 | $1,901.33 | $3,206.41 |