- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.47 / $2,546.00 / $6,446.00
| Facility | | $92.47 | $2,546.00 | $6,446.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.64 / $153.84 / $312.41
| Professional | | $30.64 | $153.84 | $312.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.04 / $206.64 / $616.05
| Facility | | $59.04 | $206.64 | $616.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.16 / $214.12 / $344.96
| Facility | | $68.16 | $214.12 | $344.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $1,775.00 / $3,560.25
| Facility | | $1,151.00 | $1,775.00 | $3,560.25 |