- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.00 / $1,831.00 / $2,825.00
| Facility | | $784.00 | $1,831.00 | $2,825.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,096.15 / $9,096.15 / $10,005.77
| Facility | | $9,096.15 | $9,096.15 | $10,005.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,698.66 / $2,698.66 / $2,698.66
| Professional | | $2,698.66 | $2,698.66 | $2,698.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $3,226.00 / $8,974.00
| Facility | | $860.00 | $3,226.00 | $8,974.00 |