- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.00 / $2,500.56 / $7,793.38
| Facility | | $634.00 | $2,500.56 | $7,793.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,907.91 / $4,145.14 / $8,051.27
| Facility | | $1,907.91 | $4,145.14 | $8,051.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.00 / $709.00 / $2,720.17
| Facility | | $450.00 | $709.00 | $2,720.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.48 / $774.68 / $1,652.03
| Professional | | $438.48 | $774.68 | $1,652.03 |
- 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 |