- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.34 / $2,351.32 / $5,493.00
| Facility | | $183.34 | $2,351.32 | $5,493.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.49 / $2,227.84 / $4,602.53
| Facility | | $781.49 | $2,227.84 | $4,602.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.31 / $709.00 / $2,720.17
| Facility | | $131.31 | $709.00 | $2,720.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.62 / $206.53 / $1,062.95
| Professional | | $135.62 | $206.53 | $1,062.95 |
- 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
- $1,116.00 / $3,624.00 / $6,195.00
| Facility | | $1,116.00 | $3,624.00 | $6,195.00 |