- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,630.27 / $6,606.93
| Facility | | $1,000.00 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $138.04 / $177.83
| Professional | | $120.23 | $138.04 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $562.34 / $1,659.59
| Facility | | $100.00 | $562.34 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $147.91 / $295.12
| Professional | | $123.03 | $147.91 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $616.60 / $1,659.59
| Facility | | $100.00 | $616.60 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $147.91 / $194.98
| Professional | | $123.03 | $147.91 | $194.98 |