- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.02 / $1,165.20 / $9,823.00
| Professional | | $556.02 | $1,165.20 | $9,823.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.00 / $576.00 / $787.00
| Facility | | $235.00 | $576.00 | $787.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.00 / $275.00 / $288.00
| Professional | | $147.00 | $275.00 | $288.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.00 / $412.00 / $412.00
| Facility | | $255.00 | $412.00 | $412.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $291.30 / $305.86
| Professional | | $30.00 | $291.30 | $305.86 |