- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.37 / $1,707.45 / $10,073.00
| Facility | | $898.37 | $1,707.45 | $10,073.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,229.59 / $10,747.92 / $20,514.54
| Facility | | $6,229.59 | $10,747.92 | $20,514.54 |
- 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
- $954.21 / $1,518.06 / $3,274.75
| Professional | | $954.21 | $1,518.06 | $3,274.75 |
- 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 / $5,978.00 / $12,241.00
| Facility | | $1,300.00 | $5,978.00 | $12,241.00 |