- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.78 / $930.00 / $4,200.00
| Facility | | $390.78 | $930.00 | $4,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,085.37 / $3,705.54 / $8,082.26
| Facility | | $2,085.37 | $3,705.54 | $8,082.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.00 / $1,631.14 / $1,820.98
| Facility | | $463.00 | $1,631.14 | $1,820.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.05 / $651.55 / $1,641.50
| Professional | | $439.05 | $651.55 | $1,641.50 |
- 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
- $1,095.00 / $2,588.00 / $4,780.00
| Facility | | $1,095.00 | $2,588.00 | $4,780.00 |