- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,807.00 / $4,387.00 / $10,439.00
| Facility | | $1,807.00 | $4,387.00 | $10,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.50 / $224.25 / $1,800.00
| Professional | | $148.50 | $224.25 | $1,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.47 / $158.21 / $158.21
| Professional | | $134.47 | $158.21 | $158.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $852.00 / $2,746.00
| Facility | | $55.00 | $852.00 | $2,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.78 / $786.00 / $2,746.00
| Facility | | $463.78 | $786.00 | $2,746.00 |