- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,862.09 / $7,244.36
| Facility | | $380.19 | $1,862.09 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,238.72 / $3,311.31
| Facility | | $831.76 | $2,238.72 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,000.00 / $1,698.24
| Facility | | $302.00 | $1,000.00 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $645.65 / $1,122.02
| Professional | | $117.49 | $645.65 | $1,122.02 |
- 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
- $831.76 / $2,238.72 / $4,786.30
| Facility | | $831.76 | $2,238.72 | $4,786.30 |