- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.42 / $1,620.00 / $5,430.00
| Facility | | $515.42 | $1,620.00 | $5,430.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,102.66 / $6,973.45 / $9,913.41
| Facility | | $3,102.66 | $6,973.45 | $9,913.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $875.00 / $908.00
| Facility | | $875.00 | $875.00 | $908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.40 / $535.54 / $1,513.98
| Professional | | $345.40 | $535.54 | $1,513.98 |
- 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
- $1,300.00 / $5,978.00 / $12,241.00
| Facility | | $1,300.00 | $5,978.00 | $12,241.00 |