- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,870.00 / $3,757.00 / $5,743.00
| Facility | | $2,870.00 | $3,757.00 | $5,743.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.00 / $2,843.00 / $4,387.00
| Professional | | $1,023.00 | $2,843.00 | $4,387.00 |
- 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
- $5,302.41 / $7,227.26 / $10,532.19
| Facility | | $5,302.41 | $7,227.26 | $10,532.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $3,613.00 / $7,048.00
| Facility | | $1,981.00 | $3,613.00 | $7,048.00 |