- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.06 / $1,842.00 / $5,091.00
| Facility | | $347.06 | $1,842.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,167.76 / $2,471.82 / $3,568.02
| Facility | | $1,167.76 | $2,471.82 | $3,568.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.80 / $643.00 / $1,681.46
| Facility | | $204.80 | $643.00 | $1,681.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.98 / $302.80 / $885.42
| Professional | | $207.98 | $302.80 | $885.42 |
- 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 |