- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,280.34 / $7,629.00 / $10,492.00
| Facility | | $4,280.34 | $7,629.00 | $10,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.84 / $121.43 / $169.55
| Facility | | $55.84 | $121.43 | $169.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.67 / $21.96 / $24.41
| Professional | | $18.67 | $21.96 | $24.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,347.00 / $3,983.00 / $6,832.00
| Facility | | $1,347.00 | $3,983.00 | $6,832.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.65 / $111.25 / $245.73
| Professional | | $76.65 | $111.25 | $245.73 |