- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.57 / $1,289.00 / $5,091.00
| Facility | | $231.57 | $1,289.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.86 / $1,403.52 / $2,810.54
| Facility | | $643.86 | $1,403.52 | $2,810.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.12 / $400.00 / $1,300.00
| Facility | | $134.12 | $400.00 | $1,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.31 / $211.72 / $596.69
| Professional | | $136.31 | $211.72 | $596.69 |
- 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
- $815.00 / $2,622.00 / $5,161.00
| Facility | | $815.00 | $2,622.00 | $5,161.00 |