- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.65 / $1,411.00 / $5,091.00
| Facility | | $337.65 | $1,411.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,228.13 / $4,246.47 / $6,183.88
| Facility | | $2,228.13 | $4,246.47 | $6,183.88 |
- 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
- $220.61 / $331.32 / $751.40
| Professional | | $220.61 | $331.32 | $751.40 |
- 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
- $930.00 / $3,951.00 / $6,625.00
| Facility | | $930.00 | $3,951.00 | $6,625.00 |