- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.10 / $5,063.00 / $9,488.00
| Facility | | $152.10 | $5,063.00 | $9,488.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.05 / $167.48 / $894.04
| Professional | | $149.05 | $167.48 | $894.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.53 / $227.00 / $339.25
| Professional | | $153.53 | $227.00 | $339.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.59 / $240.16 / $261.86
| Facility | | $180.59 | $240.16 | $261.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.76 / $225.86 / $402.48
| Professional | | $223.76 | $225.86 | $402.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.82 / $196.82 / $236.18
| Professional | | $196.82 | $196.82 | $236.18 |