- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.93 / $941.00 / $4,500.00
| Facility | | $207.93 | $941.00 | $4,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.76 / $1,213.93 / $2,647.75
| Facility | | $548.76 | $1,213.93 | $2,647.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $620.00 / $643.00
| Facility | | $620.00 | $620.00 | $643.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.56 / $326.31 / $1,030.18
| Professional | | $169.56 | $326.31 | $1,030.18 |
- 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
- $165.00 / $1,032.00 / $3,686.00
| Facility | | $165.00 | $1,032.00 | $3,686.00 |