- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.38 / $1,124.32 / $5,091.00
| Facility | | $182.38 | $1,124.32 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.07 / $1,236.08 / $1,856.11
| Facility | | $616.07 | $1,236.08 | $1,856.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.57 / $785.00 / $979.50
| Facility | | $161.57 | $785.00 | $979.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.69 / $647.24 / $1,273.71
| Professional | | $128.69 | $647.24 | $1,273.71 |
- 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 |