- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.00 / $2,118.00 / $5,549.00
| Facility | | $813.00 | $2,118.00 | $5,549.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.52 / $7,831.58 / $12,638.15
| Facility | | $3,981.52 | $7,831.58 | $12,638.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.00 / $716.56 / $5,676.58
| Facility | | $450.00 | $716.56 | $5,676.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.38 / $1,040.58 / $2,552.67
| Professional | | $676.38 | $1,040.58 | $2,552.67 |
- 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
- $2,100.00 / $5,951.00 / $11,831.32
| Facility | | $2,100.00 | $5,951.00 | $11,831.32 |