- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.16 / $1,842.00 / $9,020.15
| Facility | | $518.16 | $1,842.00 | $9,020.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,674.13 / $3,581.04 / $7,171.03
| Facility | | $1,674.13 | $3,581.04 | $7,171.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $875.00 / $908.00
| Facility | | $875.00 | $875.00 | $908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.28 / $518.50 / $1,487.07
| Professional | | $335.28 | $518.50 | $1,487.07 |
- 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
- $578.00 / $2,873.00 / $7,384.00
| Facility | | $578.00 | $2,873.00 | $7,384.00 |