- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.06 / $1,451.00 / $5,389.00
| Facility | | $325.06 | $1,451.00 | $5,389.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.85 / $1,731.76 / $3,342.87
| Facility | | $863.85 | $1,731.76 | $3,342.87 |
- 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
- $195.57 / $293.54 / $1,056.85
| Professional | | $195.57 | $293.54 | $1,056.85 |
- 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 / $2,624.24 / $4,780.00
| Facility | | $815.00 | $2,624.24 | $4,780.00 |