- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.56 / $3,649.50 / $8,373.50
| Facility | | $287.56 | $3,649.50 | $8,373.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.56 / $287.56 / $287.56
| Professional | | $287.56 | $287.56 | $287.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,691.00 / $3,366.00 / $4,707.00
| Facility | | $1,691.00 | $3,366.00 | $4,707.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.03
| Professional | | $0.02 | $0.02 | $0.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.68 / $510.68 / $528.19
| Facility | | $510.68 | $510.68 | $528.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $2,017.00 / $4,102.00
| Facility | | $1,020.00 | $2,017.00 | $4,102.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,455.03 / $1,880.48 / $2,122.38
| Professional | | $1,455.03 | $1,880.48 | $2,122.38 |