- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.05 / $2,079.00 / $5,611.69
| Facility | | $441.05 | $2,079.00 | $5,611.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,179.36 / $2,713.07 / $5,096.12
| Facility | | $1,179.36 | $2,713.07 | $5,096.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $1,300.00 / $4,506.00
| Facility | | $400.00 | $1,300.00 | $4,506.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.87 / $448.31 / $1,887.65
| Professional | | $298.87 | $448.31 | $1,887.65 |
- 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 |