- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.83 / $1,433.35 / $5,091.00
| Facility | | $671.83 | $1,433.35 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,100.08 / $7,202.55 / $15,709.69
| Facility | | $4,100.08 | $7,202.55 | $15,709.69 |
- 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
- $728.48 / $1,085.41 / $2,888.52
| Professional | | $728.48 | $1,085.41 | $2,888.52 |
- 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 |