- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,384.00 / $5,647.00 / $10,871.00
| Facility | | $2,384.00 | $5,647.00 | $10,871.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,286.00 / $5,158.80 / $11,298.00
| Professional | | $2,286.00 | $5,158.80 | $11,298.00 |
- 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 / $486.18 / $1,264.67
| Facility | | $470.65 | $486.18 | $1,264.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $3,339.00 / $9,152.00
| Facility | | $1,200.00 | $3,339.00 | $9,152.00 |