- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.05 / $2,563.00 / $7,723.00
| Facility | | $280.05 | $2,563.00 | $7,723.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,578.13 / $3,425.26 / $5,402.48
| Facility | | $1,578.13 | $3,425.26 | $5,402.48 |
- 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
- $175.28 / $268.98 / $1,096.33
| Professional | | $175.28 | $268.98 | $1,096.33 |
- 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 |