- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $726.64 / $1,835.00 / $5,091.00
| Facility | | $726.64 | $1,835.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,304.09 / $10,202.07 / $16,991.50
| Facility | | $7,304.09 | $10,202.07 | $16,991.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $6,831.39 / $7,626.43
| Facility | | $620.00 | $6,831.39 | $7,626.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.72 / $1,194.52 / $2,977.26
| Professional | | $815.72 | $1,194.52 | $2,977.26 |
- 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 |