- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.04 / $1,450.42 / $5,091.00
| Facility | | $652.04 | $1,450.42 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,979.36 / $6,990.48 / $15,247.12
| Facility | | $3,979.36 | $6,990.48 | $15,247.12 |
- 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
- $689.87 / $1,037.75 / $2,406.80
| Professional | | $689.87 | $1,037.75 | $2,406.80 |
- 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 |