- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.01 / $1,451.00 / $5,146.89
| Facility | | $182.01 | $1,451.00 | $5,146.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.64 / $1,283.52 / $2,638.58
| Facility | | $688.64 | $1,283.52 | $2,638.58 |
- 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
- $107.15 / $160.72 / $570.46
| Professional | | $107.15 | $160.72 | $570.46 |
- 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 |