- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.64 / $1,411.00 / $5,091.00
| Facility | | $344.64 | $1,411.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.43 / $2,882.80 / $5,086.14
| Facility | | $1,327.43 | $2,882.80 | $5,086.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $620.00 / $643.00
| Facility | | $620.00 | $620.00 | $643.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.59 / $548.40 / $1,274.58
| Professional | | $249.59 | $548.40 | $1,274.58 |
- 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 |