- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.15 / $1,571.10 / $4,961.00
| Facility | | $527.15 | $1,571.10 | $4,961.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,683.00 / $8,161.19 / $12,138.23
| Facility | | $3,683.00 | $8,161.19 | $12,138.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $6,831.39 / $7,626.43
| Facility | | $620.00 | $6,831.39 | $7,626.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.07 / $625.61 / $1,827.28
| Professional | | $417.07 | $625.61 | $1,827.28 |
- 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 |