- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.54 / $1,083.00 / $3,109.00
| Facility | | $194.54 | $1,083.00 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.68 / $194.54 / $311.26
| Professional | | $141.68 | $194.54 | $311.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.23 / $278.69 / $384.03
| Professional | | $241.23 | $278.69 | $384.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $337.00 / $858.00
| Facility | | $130.00 | $337.00 | $858.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.94 / $227.00 / $363.92
| Professional | | $154.94 | $227.00 | $363.92 |