- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,819.70 / $5,623.41
| Facility | | $436.52 | $1,819.70 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,737.80 / $3,801.89
| Facility | | $933.25 | $1,737.80 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,000.00 / $1,230.27
| Facility | | $302.00 | $1,000.00 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $660.69 / $1,698.24
| Professional | | $302.00 | $660.69 | $1,698.24 |
- 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
- $891.25 / $2,238.72 / $4,570.88
| Facility | | $891.25 | $2,238.72 | $4,570.88 |