- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.04 / $1,568.00 / $5,091.00
| Facility | | $561.04 | $1,568.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,202.15 / $5,451.32 / $11,890.03
| Facility | | $2,202.15 | $5,451.32 | $11,890.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $1,631.14 / $1,820.98
| Facility | | $620.00 | $1,631.14 | $1,820.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.97 / $872.10 / $2,311.34
| Professional | | $598.97 | $872.10 | $2,311.34 |
- 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 |