- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.36 / $1,600.00 / $5,091.00
| Facility | | $190.36 | $1,600.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $991.14 / $2,196.28 / $3,964.02
| Facility | | $991.14 | $2,196.28 | $3,964.02 |
- 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
- $106.56 / $192.86 / $570.46
| Professional | | $106.56 | $192.86 | $570.46 |
- 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
- $553.00 / $1,905.00 / $4,342.00
| Facility | | $553.00 | $1,905.00 | $4,342.00 |