- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $414.33 / $1,165.85 / $5,091.00
| Facility | | $414.33 | $1,165.85 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,116.66 / $8,935.03 / $15,712.23
| Facility | | $4,116.66 | $8,935.03 | $15,712.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.00 / $463.00 / $480.00
| Facility | | $463.00 | $463.00 | $480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.39 / $638.64 / $1,595.48
| Professional | | $428.39 | $638.64 | $1,595.48 |
- 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
- $749.00 / $2,622.00 / $5,026.00
| Facility | | $749.00 | $2,622.00 | $5,026.00 |