- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.49 / $2,687.68 / $10,073.00
| Facility | | $950.49 | $2,687.68 | $10,073.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.78 / $8,998.48 / $18,019.45
| Facility | | $4,206.78 | $8,998.48 | $18,019.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $875.00 / $908.00
| Facility | | $875.00 | $875.00 | $908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.01 / $1,301.57 / $3,738.68
| Professional | | $798.01 | $1,301.57 | $3,738.68 |
- 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
- $578.00 / $2,873.00 / $7,384.00
| Facility | | $578.00 | $2,873.00 | $7,384.00 |