- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $1,731.00 / $5,280.71
| Facility | | $624.00 | $1,731.00 | $5,280.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,878.08 / $5,860.28 / $11,745.15
| Facility | | $3,878.08 | $5,860.28 | $11,745.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $3,072.73 / $3,430.33
| Facility | | $620.00 | $3,072.73 | $3,430.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.61 / $847.16 / $2,718.29
| Professional | | $564.61 | $847.16 | $2,718.29 |
- 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 |