- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,038.00 / $4,312.00 / $6,141.42
| Facility | | $3,038.00 | $4,312.00 | $6,141.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.97 / $1,939.66 / $2,620.00
| Professional | | $916.97 | $1,939.66 | $2,620.00 |
- 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
- $8,370.62 / $10,940.20 / $15,943.01
| Facility | | $8,370.62 | $10,940.20 | $15,943.01 |
- 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 |