- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,293.00 / $3,668.95 / $7,119.04
| Facility | | $2,293.00 | $3,668.95 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.19 / $1,023.42 / $2,046.84
| Professional | | $159.19 | $1,023.42 | $2,046.84 |
- 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
- $97.65 / $2,555.00 / $6,267.00
| Facility | | $97.65 | $2,555.00 | $6,267.00 |
- 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 |