- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.44 / $603.00 / $5,549.00
| Facility | | $337.44 | $603.00 | $5,549.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.47 / $193.70 / $314.66
| Professional | | $132.47 | $193.70 | $314.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.45 / $310.82 / $1,607.00
| Facility | | $174.45 | $310.82 | $1,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.00 / $256.94 / $370.22
| Facility | | $190.00 | $256.94 | $370.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $1,640.00 / $3,560.25
| Facility | | $1,151.00 | $1,640.00 | $3,560.25 |