- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.45 / $1,289.00 / $5,483.00
| Facility | | $166.45 | $1,289.00 | $5,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,107.01 / $2,402.71 / $3,480.71
| Facility | | $1,107.01 | $2,402.71 | $3,480.71 |
- 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
- $132.22 / $224.51 / $576.29
| Professional | | $132.22 | $224.51 | $576.29 |
- 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
- $930.00 / $3,951.00 / $6,625.00
| Facility | | $930.00 | $3,951.00 | $6,625.00 |