- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,917.20 / $9,248.33 / $19,276.96
| Facility | | $4,917.20 | $9,248.33 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.00 / $1,489.86 / $11,100.08
| Professional | | $1,042.00 | $1,489.86 | $11,100.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.62 / $491.41 / $950.54
| Facility | | $373.62 | $491.41 | $950.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,936.00 / $2,936.00 / $2,936.00
| Facility | | $2,936.00 | $2,936.00 | $2,936.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,936.00 / $3,425.33 / $4,599.72
| Facility | | $2,936.00 | $3,425.33 | $4,599.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |