- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.22 / $1,842.00 / $5,430.00
| Facility | | $473.22 | $1,842.00 | $5,430.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,444.84 / $5,306.41 / $11,762.27
| Facility | | $2,444.84 | $5,306.41 | $11,762.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $7,701.00 / $11,011.00
| Facility | | $620.00 | $7,701.00 | $11,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.20 / $411.36 / $1,169.89
| Professional | | $275.20 | $411.36 | $1,169.89 |
- 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
- $1,152.00 / $5,000.00 / $8,995.00
| Facility | | $1,152.00 | $5,000.00 | $8,995.00 |