- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $3,090.30 / $8,511.38
| Facility | | $162.18 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $977.24 / $1,862.09
| Facility | | $363.08 | $977.24 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $588.84
| Facility | | $398.11 | $398.11 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $165.96 / $478.63
| Professional | | $95.50 | $165.96 | $478.63 |
- 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 / $812.83 / $2,630.27
| Facility | | $151.36 | $812.83 | $2,630.27 |