- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,785.80 / $10,780.21 / $17,127.43
| Facility | | $6,785.80 | $10,780.21 | $17,127.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.30 / $60.40 / $66.31
| Professional | | $48.30 | $60.40 | $66.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.33 / $357.64 / $1,676.40
| Facility | | $39.33 | $357.64 | $1,676.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.42 / $77.62 / $2,708.00
| Professional | | $47.42 | $77.62 | $2,708.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.60 / $64.17 / $246.11
| Professional | | $43.60 | $64.17 | $246.11 |