- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $2,041.74 / $7,413.10
| Facility | | $331.13 | $2,041.74 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,230.27 / $2,344.23
| Facility | | $457.09 | $1,230.27 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $204.17 / $537.03
| Professional | | $117.49 | $204.17 | $537.03 |
- 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 / $831.76 / $2,344.23
| Facility | | $151.36 | $831.76 | $2,344.23 |