- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.06 / $2,145.78 / $7,838.38
| Facility | | $154.06 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.06 / $508.80 / $779.66
| Professional | | $154.06 | $508.80 | $779.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.53 / $688.24 / $1,180.27
| Facility | | $197.53 | $688.24 | $1,180.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.12 / $134.12 / $134.12
| Professional | | $134.12 | $134.12 | $134.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.00 / $1,158.00 / $1,401.00
| Facility | | $230.00 | $1,158.00 | $1,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.65 / $67.12 / $81.52
| Professional | | $53.65 | $67.12 | $81.52 |