- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.66 / $1,568.00 / $5,091.00
| Facility | | $149.66 | $1,568.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.93 / $868.32 / $1,738.81
| Facility | | $405.93 | $868.32 | $1,738.81 |
- 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
- $102.71 / $193.35 / $630.76
| Professional | | $102.71 | $193.35 | $630.76 |
- 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 / $963.00 / $3,686.00
| Facility | | $165.00 | $963.00 | $3,686.00 |