- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $8,763.29 / $14,860.56
| Facility | | $1,000.00 | $8,763.29 | $14,860.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $2,719.84 / $2,719.85
| Professional | | $40.00 | $2,719.84 | $2,719.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.00 / $24.00 / $24.00
| Professional | | $24.00 | $24.00 | $24.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.00 / $85.00 / $1,500.00
| Professional | | $85.00 | $85.00 | $1,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.00 / $24.00 / $24.00
| Professional | | $24.00 | $24.00 | $24.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.00 / $4,262.00 / $17,636.00
| Facility | | $3,085.00 | $4,262.00 | $17,636.00 |