- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.52 / $1,207.00 / $4,634.00
| Facility | | $254.52 | $1,207.00 | $4,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.62 / $2,199.10 / $3,223.25
| Facility | | $856.62 | $2,199.10 | $3,223.25 |
- 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
- $180.11 / $526.38 / $1,241.40
| Professional | | $180.11 | $526.38 | $1,241.40 |
- 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
- $1,098.00 / $3,951.00 / $6,482.00
| Facility | | $1,098.00 | $3,951.00 | $6,482.00 |