- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $3,090.30 / $8,511.38
| Facility | | $154.88 | $3,090.30 | $8,511.38 |
- 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
- $100.00 / $162.18 / $446.68
| Professional | | $100.00 | $162.18 | $446.68 |
- 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
- $575.44 / $2,884.03 / $7,413.10
| Facility | | $575.44 | $2,884.03 | $7,413.10 |