- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.61 / $3,038.00 / $4,387.00
| Facility | | $170.61 | $3,038.00 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.00 / $508.20 / $1,062.36
| Professional | | $112.00 | $508.20 | $1,062.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $45.00 / $60.00
| Professional | | $30.00 | $45.00 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.07 / $379.59 / $553.17
| Facility | | $297.07 | $379.59 | $553.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,556.00 / $4,495.00
| Facility | | $1,078.00 | $1,556.00 | $4,495.00 |