- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.77 / $2,989.00 / $14,756.00
| Facility | | $671.77 | $2,989.00 | $14,756.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,752.46 / $10,053.12 / $15,708.25
| Facility | | $6,752.46 | $10,053.12 | $15,708.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $6,831.39 / $7,626.43
| Facility | | $875.00 | $6,831.39 | $7,626.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.32 / $1,107.28 / $2,825.14
| Professional | | $754.32 | $1,107.28 | $2,825.14 |
- 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
- $2,575.00 / $6,920.00 / $14,716.00
| Facility | | $2,575.00 | $6,920.00 | $14,716.00 |