- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.36 / $3,633.00 / $8,920.00
| Facility | | $343.36 | $3,633.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.83 / $323.80 / $399.35
| Professional | | $269.83 | $323.80 | $399.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.49 / $405.78 / $580.28
| Facility | | $308.49 | $405.78 | $580.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.32 / $408.29 / $1,380.00
| Facility | | $309.32 | $408.29 | $1,380.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.00 / $1,045.00 / $2,364.00
| Facility | | $296.00 | $1,045.00 | $2,364.00 |