- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $631.45 / $1,415.21 / $5,091.00
| Facility | | $631.45 | $1,415.21 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,889.58 / $6,769.72 / $14,765.63
| Facility | | $3,889.58 | $6,769.72 | $14,765.63 |
- 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
- $692.45 / $1,015.23 / $2,705.61
| Professional | | $692.45 | $1,015.23 | $2,705.61 |
- 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 |