- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.87 / $1,928.53 / $5,549.00
| Facility | | $985.87 | $1,928.53 | $5,549.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,094.16 / $11,876.17 / $27,627.52
| Facility | | $6,094.16 | $11,876.17 | $27,627.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $620.00 / $643.00
| Facility | | $620.00 | $620.00 | $643.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,043.48 / $1,634.58 / $5,518.69
| Professional | | $1,043.48 | $1,634.58 | $5,518.69 |
- 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
- $1,152.00 / $5,000.00 / $8,995.00
| Facility | | $1,152.00 | $5,000.00 | $8,995.00 |