- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $753.15 / $1,451.00 / $5,091.00
| Facility | | $753.15 | $1,451.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,295.45 / $8,074.33 / $17,611.14
| Facility | | $4,295.45 | $8,074.33 | $17,611.14 |
- 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
- $827.20 / $1,215.89 / $3,306.86
| Professional | | $827.20 | $1,215.89 | $3,306.86 |
- 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
- $1,600.00 / $4,530.00 / $8,566.00
| Facility | | $1,600.00 | $4,530.00 | $8,566.00 |