- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.08 / $1,539.28 / $4,093.10
| Facility | | $165.08 | $1,539.28 | $4,093.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.08 / $2,056.56 / $3,000.63
| Facility | | $863.08 | $2,056.56 | $3,000.63 |
- 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
- $106.40 / $162.22 / $695.07
| Professional | | $106.40 | $162.22 | $695.07 |
- 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
- $553.00 / $1,900.00 / $4,342.00
| Facility | | $553.00 | $1,900.00 | $4,342.00 |