- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $915.06 / $1,842.00 / $10,073.00
| Facility | | $915.06 | $1,842.00 | $10,073.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,453.51 / $10,747.92 / $20,895.43
| Facility | | $5,453.51 | $10,747.92 | $20,895.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $620.00 / $643.00
| Facility | | $620.00 | $620.00 | $643.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.08 / $1,442.26 / $6,547.78
| Professional | | $932.08 | $1,442.26 | $6,547.78 |
- 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
- $1,300.00 / $5,978.00 / $12,241.00
| Facility | | $1,300.00 | $5,978.00 | $12,241.00 |