- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,862.09 / $5,623.41
| Facility | | $346.74 | $1,862.09 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $426.58 / $4,168.69
| Facility | | $316.23 | $426.58 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Facility | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $363.08 / $1,479.11
| Professional | | $208.93 | $363.08 | $1,479.11 |
- 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
- $158.49 / $724.44 / $2,187.76
| Facility | | $158.49 | $724.44 | $2,187.76 |