- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.40 / $2,000.00 / $7,254.05
| Facility | | $641.40 | $2,000.00 | $7,254.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,016.53 / $5,788.40 / $11,558.00
| Facility | | $3,016.53 | $5,788.40 | $11,558.00 |
- 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
- $437.59 / $681.74 / $1,722.25
| Professional | | $437.59 | $681.74 | $1,722.25 |
- 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
- $1,152.00 / $5,000.00 / $8,995.00
| Facility | | $1,152.00 | $5,000.00 | $8,995.00 |