- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.00 / $2,071.29 / $5,430.00
| Facility | | $923.00 | $2,071.29 | $5,430.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,761.58 / $14,463.28 / $28,962.71
| Facility | | $6,761.58 | $14,463.28 | $28,962.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $875.00 / $908.00
| Facility | | $875.00 | $875.00 | $908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,255.61 / $1,867.53 / $5,587.41
| Professional | | $1,255.61 | $1,867.53 | $5,587.41 |
- 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
- $800.00 / $2,800.00 / $7,384.00
| Facility | | $800.00 | $2,800.00 | $7,384.00 |