- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,286.00 / $5,747.00 / $10,692.00
| Facility | | $2,286.00 | $5,747.00 | $10,692.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,297.00 / $11,298.00 / $18,000.00
| Professional | | $3,297.00 | $11,298.00 | $18,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,249.45 / $55,249.45 / $55,249.45
| Professional | | $55,249.45 | $55,249.45 | $55,249.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.65 / $527.73 / $583.20
| Facility | | $470.65 | $527.73 | $583.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.00 / $2,626.00 / $5,864.00
| Facility | | $1,341.00 | $2,626.00 | $5,864.00 |