- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,488.00 / $11,009.00 / $16,007.00
| Facility | | $10,488.00 | $11,009.00 | $16,007.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,843.00 / $2,843.00 / $2,843.00
| Professional | | $2,843.00 | $2,843.00 | $2,843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,540.35 / $26,444.67 / $45,003.43
| Facility | | $15,540.35 | $26,444.67 | $45,003.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,455.00 / $8,152.00
| Facility | | $1,751.00 | $3,455.00 | $8,152.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |