- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.41 / $178.96 / $182.93
| Professional | | $156.41 | $178.96 | $182.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,518.00 / $6,548.00 / $11,809.00
| Facility | | $3,518.00 | $6,548.00 | $11,809.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.05 / $176.58 / $291.61
| Professional | | $127.05 | $176.58 | $291.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,161.00 / $3,161.00 / $3,163.00
| Facility | | $3,161.00 | $3,161.00 | $3,163.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.82 / $162.81 / $301.07
| Professional | | $112.82 | $162.81 | $301.07 |