- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.00 / $2,964.03 / $7,255.25
| Facility | | $974.00 | $2,964.03 | $7,255.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,295.45 / $8,121.24 / $17,713.45
| Facility | | $4,295.45 | $8,121.24 | $17,713.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $996.00 / $3,072.73 / $3,430.33
| Facility | | $996.00 | $3,072.73 | $3,430.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.16 / $1,221.13 / $2,989.22
| Professional | | $746.16 | $1,221.13 | $2,989.22 |
- 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 / $3,493.00 / $6,482.00
| Facility | | $1,600.00 | $3,493.00 | $6,482.00 |