- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.06 / $661.27 / $3,140.00
| Facility | | $186.06 | $661.27 | $3,140.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.89 / $100.88 / $111.25
| Professional | | $70.89 | $100.88 | $111.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.08 / $111.40 / $163.87
| Professional | | $74.08 | $111.40 | $163.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.31 / $720.32 / $1,940.15
| Facility | | $346.31 | $720.32 | $1,940.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.52 / $134.06 / $251.64
| Professional | | $110.52 | $134.06 | $251.64 |