- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,145.78 / $7,838.38
| Facility | | $1,000.00 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.59 / $614.54 / $1,001.38
| Facility | | $167.59 | $614.54 | $1,001.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,183.00 / $1,183.00 / $1,183.00
| Professional | | $1,183.00 | $1,183.00 | $1,183.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $70.00 / $1,500.00
| Professional | | $45.00 | $70.00 | $1,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,183.00 / $1,183.00 / $1,183.00
| Professional | | $1,183.00 | $1,183.00 | $1,183.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.00 / $1,158.00 / $1,327.00
| Facility | | $230.00 | $1,158.00 | $1,327.00 |