- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $2,933.00 / $10,073.00
| Facility | | $1,017.00 | $2,933.00 | $10,073.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,889.58 / $6,794.03 / $14,818.65
| Facility | | $3,889.58 | $6,794.03 | $14,818.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $3,072.73 / $3,430.33
| Facility | | $875.00 | $3,072.73 | $3,430.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.95 / $1,068.76 / $3,189.15
| Professional | | $731.95 | $1,068.76 | $3,189.15 |
- 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 |