- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.55 / $1,207.00 / $4,634.00
| Facility | | $466.55 | $1,207.00 | $4,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,219.82 / $5,777.17 / $9,928.21
| Facility | | $2,219.82 | $5,777.17 | $9,928.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $500.00 / $5,676.58
| Facility | | $300.00 | $500.00 | $5,676.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.77 / $656.46 / $1,371.47
| Professional | | $402.77 | $656.46 | $1,371.47 |
- 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
- $1,098.00 / $3,951.00 / $6,482.00
| Facility | | $1,098.00 | $3,951.00 | $6,482.00 |