- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.09 / $577.52 / $3,002.00
| Facility | | $236.09 | $577.52 | $3,002.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.46 / $864.65 / $3,329.02
| Facility | | $219.46 | $864.65 | $3,329.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.00 / $463.00 / $480.00
| Facility | | $463.00 | $463.00 | $480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.50 / $239.09 / $648.37
| Professional | | $154.50 | $239.09 | $648.37 |
- 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
- $204.00 / $900.00 / $3,606.00
| Facility | | $204.00 | $900.00 | $3,606.00 |