- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,862.09 / $5,623.41
| Facility | | $354.81 | $1,862.09 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $691.83 / $2,041.74
| Facility | | $562.34 | $691.83 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Facility | | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $234.42 / $691.83
| Professional | | $134.90 | $234.42 | $691.83 |
- 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
- $151.36 / $741.31 / $2,187.76
| Facility | | $151.36 | $741.31 | $2,187.76 |