- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.08 / $3,038.00 / $4,387.00
| Facility | | $900.08 | $3,038.00 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $907.56 / $981.37 / $1,815.11
| Professional | | $907.56 | $981.37 | $1,815.11 |
- 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
- $3,435.37 / $4,418.50 / $6,439.02
| Facility | | $3,435.37 | $4,418.50 | $6,439.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $2,312.00 / $4,640.00
| Facility | | $1,689.00 | $2,312.00 | $4,640.00 |