- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.10 / $2,543.00 / $10,750.00
| Facility | | $716.10 | $2,543.00 | $10,750.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,878.08 / $5,772.10 / $11,552.27
| Facility | | $3,878.08 | $5,772.10 | $11,552.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.00 / $3,072.73 / $3,430.33
| Facility | | $1,383.00 | $3,072.73 | $3,430.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.24 / $960.12 / $2,094.44
| Professional | | $641.24 | $960.12 | $2,094.44 |
- 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 |