- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.76 / $2,912.34 / $13,091.58
| Facility | | $315.76 | $2,912.34 | $13,091.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.37 / $168.74 / $580.96
| Professional | | $102.37 | $168.74 | $580.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.19 / $257.58 / $1,607.00
| Facility | | $166.19 | $257.58 | $1,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.85 / $243.02 / $314.95
| Facility | | $189.85 | $243.02 | $314.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,640.00 / $2,126.00
| Facility | | $1,204.00 | $1,640.00 | $2,126.00 |