- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.41 / $1,452.00 / $4,634.00
| Facility | | $282.41 | $1,452.00 | $4,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.76 / $2,274.07 / $3,401.23
| Facility | | $937.76 | $2,274.07 | $3,401.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.55 / $875.00 / $1,681.46
| Facility | | $247.55 | $875.00 | $1,681.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.80 / $1,056.83 / $1,918.25
| Professional | | $196.80 | $1,056.83 | $1,918.25 |
- 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 |