- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.39 / $506.84 / $894.87
| Facility | | $279.39 | $506.84 | $894.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,665.16 / $3,561.84 / $7,132.58
| Facility | | $1,665.16 | $3,561.84 | $7,132.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $908.00 / $39,621.00
| Facility | | $875.00 | $908.00 | $39,621.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.83 / $462.37 / $1,079.28
| Professional | | $308.83 | $462.37 | $1,079.28 |
- 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
- $1,095.00 / $2,465.00 / $4,780.00
| Facility | | $1,095.00 | $2,465.00 | $4,780.00 |