- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.83 / $1,842.00 / $5,091.00
| Facility | | $818.83 | $1,842.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.52 / $8,460.57 / $15,852.44
| Facility | | $3,981.52 | $8,460.57 | $15,852.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $750.00 / $5,676.58
| Facility | | $400.00 | $750.00 | $5,676.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.02 / $1,322.94 / $2,491.96
| Professional | | $856.02 | $1,322.94 | $2,491.96 |
- 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
- $1,300.00 / $5,820.00 / $12,241.00
| Facility | | $1,300.00 | $5,820.00 | $12,241.00 |