- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.00 / $2,157.00 / $5,405.00
| Facility | | $711.00 | $2,157.00 | $5,405.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,729.32 / $6,646.60 / $14,497.08
| Facility | | $3,729.32 | $6,646.60 | $14,497.08 |
- 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
- $729.76 / $1,160.16 / $3,130.34
| Professional | | $729.76 | $1,160.16 | $3,130.34 |
- 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
- $1,600.00 / $3,951.00 / $6,625.00
| Facility | | $1,600.00 | $3,951.00 | $6,625.00 |