- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $2,344.23 / $8,511.38
| Facility | | $165.96 | $2,344.23 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,122.02 / $2,137.96
| Facility | | $416.87 | $1,122.02 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $154.88 / $467.74
| Professional | | $89.13 | $154.88 | $467.74 |
- 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 |