- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.67 / $813.00 / $5,389.00
| Facility | | $102.67 | $813.00 | $5,389.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $684.86 / $1,225.03 / $1,709.94
| Facility | | $684.86 | $1,225.03 | $1,709.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.00 / $1,183.75 / $1,321.51
| Facility | | $463.00 | $1,183.75 | $1,321.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.58 / $127.67 / $1,113.51
| Professional | | $84.58 | $127.67 | $1,113.51 |
- 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
- $807.00 / $1,753.00 / $4,256.00
| Facility | | $807.00 | $1,753.00 | $4,256.00 |