- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.33 / $1,842.00 / $7,407.00
| Facility | | $285.33 | $1,842.00 | $7,407.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,262.88 / $2,701.36 / $5,409.47
| Facility | | $1,262.88 | $2,701.36 | $5,409.47 |
- 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
- $257.11 / $397.36 / $1,484.59
| Professional | | $257.11 | $397.36 | $1,484.59 |
- 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 |