- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.74 / $1,609.00 / $5,483.00
| Facility | | $687.74 | $1,609.00 | $5,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,164.08 / $4,717.35 / $9,446.51
| Facility | | $2,164.08 | $4,717.35 | $9,446.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $587.00 / $908.00
| Facility | | $400.00 | $587.00 | $908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.03 / $687.74 / $1,514.64
| Professional | | $447.03 | $687.74 | $1,514.64 |
- 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 |