- 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
- $4,295.45 / $8,310.32 / $18,125.87
| Facility | | $4,295.45 | $8,310.32 | $18,125.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $3,072.73 / $3,430.33
| Facility | | $875.00 | $3,072.73 | $3,430.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.71 / $1,246.73 / $3,310.48
| Professional | | $851.71 | $1,246.73 | $3,310.48 |
- 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 |