- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $6,918.31 / $10,964.78
| Facility | | $4,466.84 | $6,918.31 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $10,000.00 / $12,302.69
| Professional | | $4,168.69 | $10,000.00 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,387.21 / $28,183.83 / $33,113.11
| Facility | | $22,387.21 | $28,183.83 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,686.94 / $69,183.10 / $100,000.00
| Facility | | $41,686.94 | $69,183.10 | $100,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $8,709.64 / $29,512.09
| Facility | | $2,454.71 | $8,709.64 | $29,512.09 |