- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.15 / $1,630.00 / $5,091.00
| Facility | | $230.15 | $1,630.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,741.43 / $3,779.69 / $5,402.48
| Facility | | $1,741.43 | $3,779.69 | $5,402.48 |
- 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
- $200.00 / $293.48 / $590.63
| Professional | | $200.00 | $293.48 | $590.63 |
- 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 / $3,975.00 / $7,295.00
| Facility | | $930.00 | $3,975.00 | $7,295.00 |