- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $636.32 / $1,785.00 / $5,393.00
| Facility | | $636.32 | $1,785.00 | $5,393.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,878.08 / $5,445.42 / $10,405.29
| Facility | | $3,878.08 | $5,445.42 | $10,405.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $3,072.73 / $3,430.33
| Facility | | $709.00 | $3,072.73 | $3,430.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.60 / $786.74 / $3,075.89
| Professional | | $516.60 | $786.74 | $3,075.89 |
- 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
- $1,600.00 / $4,530.00 / $8,566.00
| Facility | | $1,600.00 | $4,530.00 | $8,566.00 |