- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $1,621.81 / $5,888.44
| Facility | | $151.36 | $1,621.81 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,258.93 / $1,737.80
| Facility | | $724.44 | $1,258.93 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $831.76 / $1,000.00
| Facility | | $302.00 | $831.76 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $457.09 / $1,584.89
| Professional | | $123.03 | $457.09 | $1,584.89 |
- 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
- $758.58 / $2,187.76 / $4,570.88
| Facility | | $758.58 | $2,187.76 | $4,570.88 |