- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.00 / $1,731.00 / $5,091.00
| Facility | | $630.00 | $1,731.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,889.58 / $6,290.98 / $13,583.40
| Facility | | $3,889.58 | $6,290.98 | $13,583.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $3,072.73 / $3,430.33
| Facility | | $620.00 | $3,072.73 | $3,430.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.14 / $981.28 / $2,857.74
| Professional | | $670.14 | $981.28 | $2,857.74 |
- 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 |