- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.44 / $1,476.83 / $4,634.00
| Facility | | $245.44 | $1,476.83 | $4,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.36 / $2,410.66 / $3,451.18
| Facility | | $1,010.36 | $2,410.66 | $3,451.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $1,300.00 / $2,769.00
| Facility | | $400.00 | $1,300.00 | $2,769.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.47 / $259.63 / $984.93
| Professional | | $176.47 | $259.63 | $984.93 |
- 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 |