- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.18 / $1,696.00 / $6,112.47
| Facility | | $827.18 | $1,696.00 | $6,112.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,702.07 / $6,503.38 / $14,184.69
| Facility | | $3,702.07 | $6,503.38 | $14,184.69 |
- 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
- $576.37 / $897.22 / $2,240.91
| Professional | | $576.37 | $897.22 | $2,240.91 |
- 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
- $930.00 / $3,951.00 / $6,625.00
| Facility | | $930.00 | $3,951.00 | $6,625.00 |