- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,393.00 / $4,123.00 / $9,074.00
| Facility | | $2,393.00 | $4,123.00 | $9,074.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.26 / $164.06 / $333.74
| Facility | | $127.26 | $164.06 | $333.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.57 / $106.30 / $140.69
| Professional | | $100.57 | $106.30 | $140.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.40 / $113.40 / $113.40
| Facility | | $113.40 | $113.40 | $113.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $51.00
| Professional | | $30.00 | $30.00 | $51.00 |