- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.00 / $2,292.00 / $10,073.00
| Facility | | $813.00 | $2,292.00 | $10,073.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,889.58 / $6,798.76 / $14,828.97
| Facility | | $3,889.58 | $6,798.76 | $14,828.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $3,430.33 / $10,111.00
| Facility | | $709.00 | $3,430.33 | $10,111.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $711.77 / $1,042.31 / $3,527.80
| Professional | | $711.77 | $1,042.31 | $3,527.80 |
- 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 |