- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $802.93 / $2,933.00 / $7,843.00
| Facility | | $802.93 | $2,933.00 | $7,843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,878.08 / $5,760.22 / $11,528.48
| Facility | | $3,878.08 | $5,760.22 | $11,528.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $3,072.73 / $3,430.33
| Facility | | $875.00 | $3,072.73 | $3,430.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.22 / $807.65 / $2,178.62
| Professional | | $551.22 | $807.65 | $2,178.62 |
- 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 / $3,715.00 / $6,514.00
| Facility | | $1,600.00 | $3,715.00 | $6,514.00 |