- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.00 / $1,831.00 / $4,786.00
| Facility | | $784.00 | $1,831.00 | $4,786.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,254.10 / $8,254.10 / $8,254.10
| Facility | | $8,254.10 | $8,254.10 | $8,254.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,936.64 / $7,936.64 / $7,936.64
| Professional | | $7,936.64 | $7,936.64 | $7,936.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,700.00 / $4,867.00
| Facility | | $1,000.00 | $2,700.00 | $4,867.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,840.00 / $14,672.00 / $29,426.00
| Facility | | $1,840.00 | $14,672.00 | $29,426.00 |