- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.13 / $1,509.50 / $5,430.00
| Facility | | $752.13 | $1,509.50 | $5,430.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,295.45 / $8,063.42 / $17,587.34
| Facility | | $4,295.45 | $8,063.42 | $17,587.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.00 / $3,072.73 / $3,430.33
| Facility | | $463.00 | $3,072.73 | $3,430.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.71 / $1,229.10 / $3,183.72
| Professional | | $820.71 | $1,229.10 | $3,183.72 |
- 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 |