- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.67 / $2,118.00 / $5,393.00
| Facility | | $773.67 | $2,118.00 | $5,393.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,776.81 / $10,202.07 / $18,091.18
| Facility | | $7,776.81 | $10,202.07 | $18,091.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $9,271.54 / $10,350.57
| Facility | | $709.00 | $9,271.54 | $10,350.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.73 / $1,261.45 / $2,707.43
| Professional | | $861.73 | $1,261.45 | $2,707.43 |
- 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
- $2,575.00 / $6,920.00 / $14,716.00
| Facility | | $2,575.00 | $6,920.00 | $14,716.00 |