- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $3,221.00 / $7,723.00
| Facility | | $1,017.00 | $3,221.00 | $7,723.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.78 / $2.67 / $2.67
| Professional | | $1.78 | $2.67 | $2.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.04 / $58.87 / $72.41
| Facility | | $47.04 | $58.87 | $72.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.00 / $345.40 / $345.40
| Professional | | $120.00 | $345.40 | $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
- $30.00 / $30.00 / $2,500.00
| Professional | | $30.00 | $30.00 | $2,500.00 |