- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.48 / $1,305.00 / $5,372.49
| Facility | | $192.48 | $1,305.00 | $5,372.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.08 / $2,425.67 / $4,023.14
| Facility | | $1,081.08 | $2,425.67 | $4,023.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $7,701.00 / $11,011.00
| Facility | | $620.00 | $7,701.00 | $11,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.73 / $419.08 / $1,457.16
| Professional | | $234.73 | $419.08 | $1,457.16 |
- 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
- $749.00 / $2,622.00 / $5,026.00
| Facility | | $749.00 | $2,622.00 | $5,026.00 |