- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.69 / $2,576.00 / $7,469.66
| Facility | | $449.69 | $2,576.00 | $7,469.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,490.43 / $4,553.93 / $9,791.77
| Facility | | $1,490.43 | $4,553.93 | $9,791.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.44 / $785.00 / $7,906.56
| Facility | | $394.44 | $785.00 | $7,906.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.27 / $4,718.18 / $6,684.68
| Professional | | $313.27 | $4,718.18 | $6,684.68 |
- 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
- $1,400.00 / $6,920.00 / $16,667.00
| Facility | | $1,400.00 | $6,920.00 | $16,667.00 |