- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $2,344.23 / $5,623.41
| Facility | | $380.19 | $2,344.23 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,737.80 / $3,311.31
| Facility | | $933.25 | $1,737.80 | $3,311.31 |
- 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
- $208.93 / $389.05 / $1,047.13
| Professional | | $208.93 | $389.05 | $1,047.13 |
- 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
- $831.76 / $2,238.72 / $4,570.88
| Facility | | $831.76 | $2,238.72 | $4,570.88 |