- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $2,570.40 / $9,332.54
| Facility | | $199.53 | $2,570.40 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,318.26 / $2,570.40
| Facility | | $489.78 | $1,318.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,025.60 / $6,309.57
| Facility | | $3,311.31 | $6,025.60 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $186.21 / $616.60
| Professional | | $120.23 | $186.21 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $851.14 / $2,630.27
| Facility | | $151.36 | $851.14 | $2,630.27 |