- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.45 / $1,731.00 / $5,091.00
| Facility | | $602.45 | $1,731.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,451.55 / $5,059.93 / $11,663.46
| Facility | | $2,451.55 | $5,059.93 | $11,663.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $648.37 / $2,720.17
| Facility | | $400.00 | $648.37 | $2,720.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.58 / $929.91 / $1,719.96
| Professional | | $563.58 | $929.91 | $1,719.96 |
- 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
- $1,000.00 / $2,374.00 / $4,636.00
| Facility | | $1,000.00 | $2,374.00 | $4,636.00 |