- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $2,041.74 / $7,762.47
| Facility | | $234.42 | $2,041.74 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,318.26 / $1,905.46
| Facility | | $707.95 | $1,318.26 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $977.24 / $1,000.00
| Facility | | $302.00 | $977.24 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $338.84 / $588.84
| Professional | | $123.03 | $338.84 | $588.84 |
- 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 |