- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.17 / $1,365.00 / $5,091.00
| Facility | | $519.17 | $1,365.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,003.06 / $6,654.51 / $21,188.85
| Facility | | $3,003.06 | $6,654.51 | $21,188.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.00 / $19,308.23 / $21,555.33
| Facility | | $463.00 | $19,308.23 | $21,555.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.40 / $522.23 / $2,664.87
| Professional | | $345.40 | $522.23 | $2,664.87 |
- 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
- $2,600.00 / $8,100.00 / $21,651.00
| Facility | | $2,600.00 | $8,100.00 | $21,651.00 |