- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.40 / $1,486.00 / $5,091.00
| Facility | | $246.40 | $1,486.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.41 / $1,370.17 / $2,988.52
| Facility | | $273.41 | $1,370.17 | $2,988.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $620.00 / $643.00
| Facility | | $620.00 | $620.00 | $643.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.99 / $343.21 / $1,041.03
| Professional | | $190.99 | $343.21 | $1,041.03 |
- 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
- $165.00 / $1,032.00 / $3,686.00
| Facility | | $165.00 | $1,032.00 | $3,686.00 |