- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.50 / $1,842.00 / $5,091.00
| Facility | | $369.50 | $1,842.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,179.36 / $2,488.85 / $3,737.24
| Facility | | $1,179.36 | $2,488.85 | $3,737.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.85 / $643.00 / $1,681.46
| Facility | | $214.85 | $643.00 | $1,681.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.16 / $323.18 / $1,119.03
| Professional | | $220.16 | $323.18 | $1,119.03 |
- 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 |