- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.07 / $1,848.00 / $5,389.00
| Facility | | $225.07 | $1,848.00 | $5,389.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $766.06 / $1,966.61 / $3,183.71
| Facility | | $766.06 | $1,966.61 | $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
- $160.00 / $1,032.94 / $1,496.41
| Professional | | $160.00 | $1,032.94 | $1,496.41 |
- 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 |