- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.36 / $1,207.00 / $4,634.00
| Facility | | $196.36 | $1,207.00 | $4,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.87 / $1,735.08 / $3,183.71
| Facility | | $675.87 | $1,735.08 | $3,183.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,000.00 / $2,769.00
| Facility | | $300.00 | $1,000.00 | $2,769.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.38 / $361.28 / $1,175.99
| Professional | | $141.38 | $361.28 | $1,175.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.00 / $2,588.00 / $4,780.00
| Facility | | $815.00 | $2,588.00 | $4,780.00 |