- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.32 / $945.00 / $3,956.70
| Facility | | $148.32 | $945.00 | $3,956.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.41 / $1,310.31 / $2,003.43
| Facility | | $510.41 | $1,310.31 | $2,003.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,000.00 / $2,769.00
| Facility | | $300.00 | $1,000.00 | $2,769.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.92 / $604.04 / $1,054.77
| Professional | | $107.92 | $604.04 | $1,054.77 |
- 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
- $815.00 / $2,624.24 / $4,780.00
| Facility | | $815.00 | $2,624.24 | $4,780.00 |