- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.53 / $806.00 / $5,405.00
| Facility | | $335.53 | $806.00 | $5,405.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,052.08 / $2,175.50 / $5,005.41
| Facility | | $1,052.08 | $2,175.50 | $5,005.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $875.00 / $1,231.60
| Facility | | $300.00 | $875.00 | $1,231.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.57 / $463.64 / $1,031.08
| Professional | | $311.57 | $463.64 | $1,031.08 |
- 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 |