- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.12 / $2,095.00 / $5,393.00
| Facility | | $641.12 | $2,095.00 | $5,393.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.50 / $4,633.68 / $7,771.01
| Facility | | $3,340.50 | $4,633.68 | $7,771.01 |
- 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
- $399.83 / $586.44 / $1,361.86
| Professional | | $399.83 | $586.44 | $1,361.86 |
- 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 |