- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.26 / $4,791.00 / $10,692.00
| Facility | | $266.26 | $4,791.00 | $10,692.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.52 / $183.44 / $311.91
| Professional | | $113.52 | $183.44 | $311.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.86 / $269.22 / $321.02
| Professional | | $190.86 | $269.22 | $321.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.01 / $328.92 / $624.30
| Professional | | $248.01 | $328.92 | $624.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,529.00 / $3,352.00 / $10,536.00
| Facility | | $1,529.00 | $3,352.00 | $10,536.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.92 / $355.03 / $853.94
| Professional | | $176.92 | $355.03 | $853.94 |