- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.36 / $1,544.00 / $5,994.30
| Facility | | $435.36 | $1,544.00 | $5,994.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,284.98 / $4,474.45 / $7,676.86
| Facility | | $2,284.98 | $4,474.45 | $7,676.86 |
- 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
- $351.82 / $543.73 / $1,273.72
| Professional | | $351.82 | $543.73 | $1,273.72 |
- 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 |