- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.24 / $762.00 / $3,270.00
| Facility | | $190.24 | $762.00 | $3,270.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.36 / $1,314.66 / $3,058.30
| Facility | | $177.36 | $1,314.66 | $3,058.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.83 / $463.00 / $1,000.00
| Facility | | $260.83 | $463.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.19 / $410.01 / $1,092.02
| Professional | | $182.19 | $410.01 | $1,092.02 |
- 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
- $204.00 / $891.00 / $3,399.00
| Facility | | $204.00 | $891.00 | $3,399.00 |