- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.70 / $1,017.00 / $14,330.56
| Facility | | $601.70 | $1,017.00 | $14,330.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,960.43 / $4,193.43 / $8,397.36
| Facility | | $1,960.43 | $4,193.43 | $8,397.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $875.00 / $908.00
| Facility | | $875.00 | $875.00 | $908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.64 / $605.24 / $1,824.72
| Professional | | $371.64 | $605.24 | $1,824.72 |
- 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
- $578.00 / $2,873.00 / $7,384.00
| Facility | | $578.00 | $2,873.00 | $7,384.00 |