- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.31 / $1,272.00 / $5,091.00
| Facility | | $212.31 | $1,272.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.81 / $2,445.12 / $3,460.55
| Facility | | $1,024.81 | $2,445.12 | $3,460.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.03 / $785.00 / $1,681.46
| Facility | | $176.03 | $785.00 | $1,681.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.13 / $265.39 / $594.78
| Professional | | $175.13 | $265.39 | $594.78 |
- 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
- $815.00 / $2,588.00 / $4,780.00
| Facility | | $815.00 | $2,588.00 | $4,780.00 |