- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.00 / $2,912.34 / $7,119.04
| Facility | | $670.00 | $2,912.34 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.41 / $166.60 / $599.80
| Professional | | $91.41 | $166.60 | $599.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.88 / $245.48 / $2,286.40
| Facility | | $138.88 | $245.48 | $2,286.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.58 / $297.68 / $917.51
| Facility | | $185.58 | $297.68 | $917.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,482.00 / $5,454.00
| Facility | | $1,775.00 | $3,482.00 | $5,454.00 |