- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.06 / $1,017.00 / $5,091.00
| Facility | | $291.06 | $1,017.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.30 / $1,960.61 / $4,276.35
| Facility | | $886.30 | $1,960.61 | $4,276.35 |
- 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
- $213.83 / $884.26 / $1,796.33
| Professional | | $213.83 | $884.26 | $1,796.33 |
- 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
- $711.00 / $1,905.00 / $4,342.00
| Facility | | $711.00 | $1,905.00 | $4,342.00 |