- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $3,981.07 / $10,000.00
| Facility | | $549.54 | $3,981.07 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $7,762.47 / $10,471.29
| Facility | | $3,467.37 | $7,762.47 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $724.44
| Facility | | $575.44 | $575.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $645.65 / $2,398.83
| Professional | | $380.19 | $645.65 | $2,398.83 |
- 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
- $1,905.46 / $5,370.32 / $12,302.69
| Facility | | $1,905.46 | $5,370.32 | $12,302.69 |