- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.89 / $1,365.00 / $5,100.47
| Facility | | $572.89 | $1,365.00 | $5,100.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,907.91 / $4,262.77 / $8,412.43
| Facility | | $1,907.91 | $4,262.77 | $8,412.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $500.00 / $2,720.17
| Facility | | $300.00 | $500.00 | $2,720.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.02 / $809.06 / $1,585.45
| Professional | | $455.02 | $809.06 | $1,585.45 |
- 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 |