- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $538.00 / $1,369.85 / $5,091.00
| Facility | | $538.00 | $1,369.85 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,878.08 / $5,445.42 / $10,018.24
| Facility | | $3,878.08 | $5,445.42 | $10,018.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.00 / $3,072.73 / $3,430.33
| Facility | | $463.00 | $3,072.73 | $3,430.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.61 / $718.83 / $1,872.56
| Professional | | $479.61 | $718.83 | $1,872.56 |
- 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
- $1,095.00 / $2,588.00 / $4,780.00
| Facility | | $1,095.00 | $2,588.00 | $4,780.00 |