- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.23 / $1,363.00 / $5,091.00
| Facility | | $501.23 | $1,363.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,878.08 / $5,847.98 / $11,720.50
| Facility | | $3,878.08 | $5,847.98 | $11,720.50 |
- 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
- $531.29 / $821.08 / $1,841.77
| Professional | | $531.29 | $821.08 | $1,841.77 |
- 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
- $1,499.00 / $3,751.00 / $6,514.00
| Facility | | $1,499.00 | $3,751.00 | $6,514.00 |