- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,737.80 / $7,762.47
| Facility | | $602.56 | $1,737.80 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,454.71 / $5,370.32
| Facility | | $1,000.00 | $2,454.71 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $3,311.31
| Facility | | $302.00 | $302.00 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $562.34 / $1,862.09
| Professional | | $269.15 | $562.34 | $1,862.09 |
- 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
- $2,884.03 / $5,888.44 / $9,772.37
| Facility | | $2,884.03 | $5,888.44 | $9,772.37 |