- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $3,684.00 / $18,600.00
| Facility | | $1,300.00 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,652.17 / $1,652.17 / $1,652.17
| Professional | | $1,652.17 | $1,652.17 | $1,652.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.00 / $406.00 / $483.00
| Professional | | $287.00 | $406.00 | $483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,030.00 / $1,652.17 / $3,436.51
| Facility | | $1,030.00 | $1,652.17 | $3,436.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,760.00 / $6,155.68
| Facility | | $350.00 | $1,760.00 | $6,155.68 |