- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $406.48 / $4,667.00 / $10,202.00
| Facility | | $406.48 | $4,667.00 | $10,202.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.99 / $272.77 / $406.48
| Professional | | $82.99 | $272.77 | $406.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.23 / $128.54 / $152.46
| Professional | | $71.23 | $128.54 | $152.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.92 / $102.78 / $176.72
| Professional | | $73.92 | $102.78 | $176.72 |
- 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
- $68.90 / $118.23 / $224.89
| Professional | | $68.90 | $118.23 | $224.89 |