- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.00 / $1,009.98 / $12,823.52
| Facility | | $202.00 | $1,009.98 | $12,823.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.42 / $302.68 / $392.99
| Professional | | $198.42 | $302.68 | $392.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.38 / $304.52 / $518.21
| Professional | | $199.38 | $304.52 | $518.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,931.85 / $12,854.64 / $13,593.50
| Facility | | $5,931.85 | $12,854.64 | $13,593.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.01 / $377.89 / $775.18
| Professional | | $292.01 | $377.89 | $775.18 |