- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.63 / $1,835.00 / $5,389.00
| Facility | | $589.63 | $1,835.00 | $5,389.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,371.67 / $5,035.07 / $9,087.21
| Facility | | $2,371.67 | $5,035.07 | $9,087.21 |
- 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
- $345.40 / $547.52 / $1,715.00
| Professional | | $345.40 | $547.52 | $1,715.00 |
- 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
- $1,282.00 / $3,751.00 / $6,874.00
| Facility | | $1,282.00 | $3,751.00 | $6,874.00 |