- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.72 / $1,384.11 / $5,252.42
| Facility | | $376.72 | $1,384.11 | $5,252.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,179.36 / $2,610.23 / $4,497.85
| Facility | | $1,179.36 | $2,610.23 | $4,497.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $908.00 / $2,769.00
| Facility | | $400.00 | $908.00 | $2,769.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.84 / $387.80 / $1,080.55
| Professional | | $254.84 | $387.80 | $1,080.55 |
- 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
- $1,183.00 / $2,435.00 / $4,636.00
| Facility | | $1,183.00 | $2,435.00 | $4,636.00 |