- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.00 / $2,747.00 / $5,725.12
| Facility | | $923.00 | $2,747.00 | $5,725.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,295.45 / $7,828.22 / $17,074.33
| Facility | | $4,295.45 | $7,828.22 | $17,074.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $3,072.73 / $3,430.33
| Facility | | $709.00 | $3,072.73 | $3,430.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.02 / $1,205.10 / $3,698.75
| Professional | | $823.02 | $1,205.10 | $3,698.75 |
- 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
- $1,600.00 / $4,530.00 / $8,566.00
| Facility | | $1,600.00 | $4,530.00 | $8,566.00 |