- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.87 / $950.12 / $5,031.96
| Facility | | $454.87 | $950.12 | $5,031.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.64 / $2,356.38 / $4,548.58
| Facility | | $966.64 | $2,356.38 | $4,548.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $480.00 / $1,378.17
| Facility | | $300.00 | $480.00 | $1,378.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.17 / $691.38 / $1,488.00
| Professional | | $317.17 | $691.38 | $1,488.00 |
- 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 / $2,588.00 / $4,780.00
| Facility | | $815.00 | $2,588.00 | $4,780.00 |