- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.08 / $3,038.00 / $4,387.00
| Facility | | $431.08 | $3,038.00 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.45 / $431.08 / $468.68
| Professional | | $362.45 | $431.08 | $468.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $45.00 / $60.00
| Professional | | $30.00 | $45.00 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.52 / $500.58 / $570.29
| Professional | | $450.52 | $500.58 | $570.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,312.00 / $2,446.00 / $13,847.00
| Facility | | $2,312.00 | $2,446.00 | $13,847.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.17 / $522.79 / $885.82
| Professional | | $405.17 | $522.79 | $885.82 |