- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.44 / $2,235.00 / $5,483.00
| Facility | | $302.44 | $2,235.00 | $5,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.71 / $2,768.38 / $4,602.53
| Facility | | $1,071.71 | $2,768.38 | $4,602.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.06 / $709.00 / $2,720.17
| Facility | | $270.06 | $709.00 | $2,720.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.53 / $410.28 / $884.31
| Professional | | $214.53 | $410.28 | $884.31 |
- 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 |