- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $3,363.00 / $7,276.00
| Facility | | $2,663.12 | $3,363.00 | $7,276.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,430.00 / $19,430.00 / $19,430.00
| Professional | | $19,430.00 | $19,430.00 | $19,430.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,237.00 / $7,775.00 / $21,140.00
| Facility | | $2,237.00 | $7,775.00 | $21,140.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $9,788.00 / $12,860.94
| Facility | | $3,000.00 | $9,788.00 | $12,860.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,504.00 / $9,239.00
| Facility | | $83.43 | $3,504.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,001.12 / $34,501.37 / $42,950.00
| Professional | | $28,001.12 | $34,501.37 | $42,950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,237.00 / $7,775.00 / $21,140.00
| Facility | | $2,237.00 | $7,775.00 | $21,140.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,594.00 / $7,775.00 / $16,522.00
| Facility | | $2,594.00 | $7,775.00 | $16,522.00 |