- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.35 / $1,694.00 / $8,824.87
| Facility | | $567.35 | $1,694.00 | $8,824.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,956.13 / $7,732.44 / $11,482.25
| Facility | | $3,956.13 | $7,732.44 | $11,482.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $3,082.00 / $10,223.00
| Facility | | $620.00 | $3,082.00 | $10,223.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.05 / $689.52 / $2,657.66
| Professional | | $461.05 | $689.52 | $2,657.66 |
- 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
- $2,100.00 / $5,820.00 / $12,241.00
| Facility | | $2,100.00 | $5,820.00 | $12,241.00 |