- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,710.00 / $5,050.50 / $18,409.30
| Facility | | $3,710.00 | $5,050.50 | $18,409.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.00 / $4,165.00 / $4,550.00
| Professional | | $2,100.00 | $4,165.00 | $4,550.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,789.80 / $6,835.15 / $10,770.20
| Facility | | $3,789.80 | $6,835.15 | $10,770.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.91 / $657.70 / $730.05
| Professional | | $597.91 | $657.70 | $730.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,500.00 / $3,500.00 / $3,500.00
| Facility | | $3,500.00 | $3,500.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,275.00 / $3,781.50 / $26,572.04
| Facility | | $2,275.00 | $3,781.50 | $26,572.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.00 / $2,100.00 / $4,900.00
| Professional | | $1,470.00 | $2,100.00 | $4,900.00 |