- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.00 / $5,549.00 / $7,119.04
| Facility | | $603.00 | $5,549.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,131.90 / $1,551.91 / $1,590.71
| Professional | | $1,131.90 | $1,551.91 | $1,590.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $150.00 / $150.00
| Professional | | $150.00 | $150.00 | $150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.10 / $763.88 / $2,126.00
| Facility | | $362.10 | $763.88 | $2,126.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $1,775.00 / $3,560.25
| Facility | | $1,151.00 | $1,775.00 | $3,560.25 |