- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,583.50 / $2,912.34 / $7,119.04
| Facility | | $1,583.50 | $2,912.34 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.56 / $385.60 / $670.40
| Professional | | $135.56 | $385.60 | $670.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $150.00 / $150.00
| Professional | | $150.00 | $150.00 | $150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.47 / $887.22 / $1,966.00
| Facility | | $282.47 | $887.22 | $1,966.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,546.56 / $6,546.56 / $6,546.56
| Facility | | $6,546.56 | $6,546.56 | $6,546.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $1,623.00 / $3,560.25
| Facility | | $1,151.00 | $1,623.00 | $3,560.25 |