- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.00 / $2,758.00 / $5,580.00
| Facility | | $813.00 | $2,758.00 | $5,580.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,639.75 / $10,202.07 / $17,772.34
| Facility | | $7,639.75 | $10,202.07 | $17,772.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $6,831.39 / $7,626.43
| Facility | | $875.00 | $6,831.39 | $7,626.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.91 / $1,274.30 / $3,254.34
| Professional | | $865.91 | $1,274.30 | $3,254.34 |
- 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 / $4,530.00 / $8,566.00
| Facility | | $1,600.00 | $4,530.00 | $8,566.00 |