- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.67 / $1,882.00 / $5,091.00
| Facility | | $460.67 | $1,882.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,179.36 / $2,630.56 / $4,640.43
| Facility | | $1,179.36 | $2,630.56 | $4,640.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.16 / $643.00 / $1,681.46
| Facility | | $269.16 | $643.00 | $1,681.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.61 / $391.06 / $1,461.89
| Professional | | $272.61 | $391.06 | $1,461.89 |
- 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 |