- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.17 / $3,073.00 / $8,108.37
| Facility | | $563.17 | $3,073.00 | $8,108.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,020.01 / $3,548.52 / $7,739.77
| Facility | | $2,020.01 | $3,548.52 | $7,739.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $1,631.14 / $1,820.98
| Facility | | $709.00 | $1,631.14 | $1,820.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.39 / $551.20 / $1,729.90
| Professional | | $373.39 | $551.20 | $1,729.90 |
- 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
- $1,499.00 / $3,751.00 / $6,514.00
| Facility | | $1,499.00 | $3,751.00 | $6,514.00 |