- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.79 / $1,207.00 / $5,091.00
| Facility | | $501.79 | $1,207.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,788.44 / $3,603.88 / $6,504.24
| Facility | | $2,788.44 | $3,603.88 | $6,504.24 |
- 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
- $327.78 / $626.89 / $1,646.18
| Professional | | $327.78 | $626.89 | $1,646.18 |
- 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
- $1,080.00 / $3,951.00 / $6,625.00
| Facility | | $1,080.00 | $3,951.00 | $6,625.00 |