- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.12 / $3,232.00 / $10,439.00
| Facility | | $217.12 | $3,232.00 | $10,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.43 / $131.59 / $207.47
| Professional | | $116.43 | $131.59 | $207.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.82 / $336.82 / $336.82
| Professional | | $336.82 | $336.82 | $336.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.43 / $131.59 / $369.77
| Facility | | $116.43 | $131.59 | $369.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.46 / $293.74 / $1,114.76
| Professional | | $186.46 | $293.74 | $1,114.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.37 / $272.12 / $383.15
| Professional | | $158.37 | $272.12 | $383.15 |