- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,038.00 / $5,743.00 / $8,659.00
| Facility | | $3,038.00 | $5,743.00 | $8,659.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,820.00 / $2,843.00 / $7,511.00
| Professional | | $1,820.00 | $2,843.00 | $7,511.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $45.00 / $60.00
| Professional | | $30.00 | $45.00 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,655.89 / $7,825.28 / $11,234.31
| Facility | | $5,655.89 | $7,825.28 | $11,234.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $7,693.00 / $13,847.00
| Facility | | $2,912.00 | $7,693.00 | $13,847.00 |