- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,407.00 / $4,500.00 / $7,045.00
| Facility | | $1,407.00 | $4,500.00 | $7,045.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.70 / $1,374.40 / $1,718.00
| Professional | | $196.70 | $1,374.40 | $1,718.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $55.00 / $3,900.00
| Professional | | $30.00 | $55.00 | $3,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.09 / $1,853.08 / $2,769.18
| Facility | | $1,146.09 | $1,853.08 | $2,769.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,620.00 / $4,150.00 / $4,441.00
| Facility | | $2,620.00 | $4,150.00 | $4,441.00 |