- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.21 / $1,972.00 / $5,393.00
| Facility | | $715.21 | $1,972.00 | $5,393.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,883.01 / $5,788.40 / $11,046.42
| Facility | | $2,883.01 | $5,788.40 | $11,046.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $709.00 / $735.00
| Facility | | $709.00 | $709.00 | $735.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.40 / $695.51 / $1,608.71
| Professional | | $447.40 | $695.51 | $1,608.71 |
- 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 |