- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $744.00 / $2,912.34 / $7,119.04
| Facility | | $744.00 | $2,912.34 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.88 / $290.11 / $920.60
| Professional | | $115.88 | $290.11 | $920.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.50 / $391.25 / $2,286.40
| Facility | | $175.50 | $391.25 | $2,286.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.73 / $501.44 / $917.51
| Facility | | $246.73 | $501.44 | $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 |