- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.00 / $1,421.64 / $5,519.00
| Facility | | $735.00 | $1,421.64 | $5,519.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,391.77 / $8,551.62 / $11,972.27
| Facility | | $4,391.77 | $8,551.62 | $11,972.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $3,082.00 / $10,223.00
| Facility | | $875.00 | $3,082.00 | $10,223.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.82 / $1,286.88 / $2,986.16
| Professional | | $625.82 | $1,286.88 | $2,986.16 |
- 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
- $2,537.00 / $6,885.00 / $14,716.00
| Facility | | $2,537.00 | $6,885.00 | $14,716.00 |