- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.52 / $2,562.00 / $4,050.00
| Facility | | $60.52 | $2,562.00 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.79 / $57.95 / $66.06
| Professional | | $56.79 | $57.95 | $66.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,135.14 / $7,795.18 / $11,905.69
| Facility | | $4,135.14 | $7,795.18 | $11,905.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $10,810.00
| Facility | | $1,141.00 | $4,717.00 | $10,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.63 / $55.38 / $119.23
| Professional | | $29.63 | $55.38 | $119.23 |