- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,331.21 / $10,782.23
| Facility | | $100.00 | $2,331.21 | $10,782.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.50 / $805.00 / $1,110.00
| Professional | | $472.50 | $805.00 | $1,110.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,334.70 / $11,483.00 / $21,862.00
| Facility | | $10,334.70 | $11,483.00 | $21,862.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.27 / $291.52 / $355.58
| Professional | | $285.27 | $291.52 | $355.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $3,360.00 / $7,448.00
| Facility | | $75.00 | $3,360.00 | $7,448.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,750.00 / $3,375.00 / $4,735.00
| Professional | | $2,750.00 | $3,375.00 | $4,735.00 |