- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.38 / $1,842.00 / $10,073.00
| Facility | | $483.38 | $1,842.00 | $10,073.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $785.60 / $2,201.41 / $8,672.18
| Facility | | $785.60 | $2,201.41 | $8,672.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,140.00 / $14,000.00 / $19,116.00
| Facility | | $7,140.00 | $14,000.00 | $19,116.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.05 / $490.40 / $2,381.11
| Professional | | $343.05 | $490.40 | $2,381.11 |
- 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
- $1,602.00 / $7,500.00 / $14,716.00
| Facility | | $1,602.00 | $7,500.00 | $14,716.00 |