- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,293.00 / $3,585.87 / $7,119.04
| Facility | | $2,293.00 | $3,585.87 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.56 / $824.00 / $3,048.00
| Professional | | $787.56 | $824.00 | $3,048.00 |
- 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
- $1,321.02 / $2,776.26 / $7,305.00
| Facility | | $1,321.02 | $2,776.26 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $4,663.00 / $7,305.00
| Facility | | $1,770.00 | $4,663.00 | $7,305.00 |