- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,010.01 / $12,265.50 / $44,708.30
| Facility | | $9,010.01 | $12,265.50 | $44,708.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,100.01 / $10,115.01 / $11,050.01
| Professional | | $5,100.01 | $10,115.01 | $11,050.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,203.79 / $16,599.65 / $26,584.52
| Facility | | $9,203.79 | $16,599.65 | $26,584.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.09 / $597.91 / $663.68
| Professional | | $547.09 | $597.91 | $663.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,500.00 / $8,500.00 / $8,500.00
| Facility | | $8,500.00 | $8,500.00 | $8,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,525.00 / $5,525.00 / $5,525.00
| Facility | | $5,525.00 | $5,525.00 | $5,525.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,570.00 / $5,100.00 / $12,750.00
| Professional | | $3,570.00 | $5,100.00 | $12,750.00 |