- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.11 / $1,862.09 / $9,772.37
| Facility | | $33.11 | $1,862.09 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $977.24 / $1,548.82
| Facility | | $186.21 | $977.24 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $870.96 / $1,000.00
| Facility | | $302.00 | $870.96 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $47.86 / $190.55
| Professional | | $21.88 | $47.86 | $190.55 |
- 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
- $776.25 / $2,187.76 / $4,570.88
| Facility | | $776.25 | $2,187.76 | $4,570.88 |