- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.68 / $1,140.00 / $2,825.00
| Facility | | $248.68 | $1,140.00 | $2,825.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.27 / $265.14 / $602.48
| Professional | | $241.27 | $265.14 | $602.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.00 / $633.00 / $633.00
| Professional | | $633.00 | $633.00 | $633.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.11 / $452.30 / $640.17
| Professional | | $283.11 | $452.30 | $640.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.00 / $491.00 / $1,650.00
| Facility | | $216.00 | $491.00 | $1,650.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.33 / $316.18 / $681.91
| Professional | | $246.33 | $316.18 | $681.91 |