- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.58 / $1,517.84 / $9,529.09
| Facility | | $698.58 | $1,517.84 | $9,529.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,776.09 / $9,308.45 / $13,031.84
| Facility | | $4,776.09 | $9,308.45 | $13,031.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $9,445.42 / $12,465.00
| Facility | | $875.00 | $9,445.42 | $12,465.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.20 / $1,031.46 / $2,912.07
| Professional | | $637.20 | $1,031.46 | $2,912.07 |
- 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 / $6,202.00 / $14,468.00
| Facility | | $2,575.00 | $6,202.00 | $14,468.00 |