- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.14 / $4,396.00 / $10,300.00
| Facility | | $341.14 | $4,396.00 | $10,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,996.00 / $8,455.00 / $16,907.36
| Facility | | $6,996.00 | $8,455.00 | $16,907.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,182.00 / $15,182.00 / $15,182.00
| Facility | | $15,182.00 | $15,182.00 | $15,182.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.08 / $348.42 / $502.31
| Professional | | $4.08 | $348.42 | $502.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,606.00 / $6,471.00
| Facility | | $1,061.00 | $2,606.00 | $6,471.00 |