- 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
- $7,776.50 / $10,202.07 / $18,090.47
| Facility | | $7,776.50 | $10,202.07 | $18,090.47 |
- 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
- $864.48 / $1,265.49 / $3,660.01
| Professional | | $864.48 | $1,265.49 | $3,660.01 |
- 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 |