- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.00 / $1,728.00 / $4,100.00
| Facility | | $781.00 | $1,728.00 | $4,100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.84 / $199.83 / $338.63
| Professional | | $36.84 | $199.83 | $338.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,262.30 / $2,745.40 / $3,693.45
| Facility | | $2,262.30 | $2,745.40 | $3,693.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $6,323.00 / $12,422.00
| Facility | | $1,500.00 | $6,323.00 | $12,422.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.81 / $54.30 / $87.74
| Professional | | $40.81 | $54.30 | $87.74 |