- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.00 / $1,289.00 / $5,091.00
| Facility | | $463.00 | $1,289.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,878.08 / $5,445.42 / $10,568.37
| Facility | | $3,878.08 | $5,445.42 | $10,568.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $3,072.73 / $3,430.33
| Facility | | $875.00 | $3,072.73 | $3,430.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.07 / $759.22 / $1,854.45
| Professional | | $507.07 | $759.22 | $1,854.45 |
- 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 / $2,465.00 / $4,780.00
| Facility | | $1,095.00 | $2,465.00 | $4,780.00 |