- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.19 / $1,200.29 / $4,634.00
| Facility | | $526.19 | $1,200.29 | $4,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,633.85 / $2,733.09 / $7,773.19
| Facility | | $1,633.85 | $2,733.09 | $7,773.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $500.00 / $1,279.13
| Facility | | $300.00 | $500.00 | $1,279.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.46 / $751.15 / $1,849.02
| Professional | | $467.46 | $751.15 | $1,849.02 |
- 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
- $815.00 / $2,588.00 / $4,780.00
| Facility | | $815.00 | $2,588.00 | $4,780.00 |