- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.57 / $1,688.00 / $9,034.00
| Facility | | $270.57 | $1,688.00 | $9,034.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.87 / $270.57 / $288.57
| Professional | | $225.87 | $270.57 | $288.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.93 / $309.61 / $309.61
| Professional | | $233.93 | $309.61 | $309.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.77 / $357.42 / $423.00
| Professional | | $269.77 | $357.42 | $423.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,056.00 / $2,558.00
| Facility | | $375.00 | $1,056.00 | $2,558.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.07 / $262.24 / $483.01
| Professional | | $206.07 | $262.24 | $483.01 |