- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,048.00 / $11,995.87 / $24,068.03
| Facility | | $6,048.00 | $11,995.87 | $24,068.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.00 / $2,374.88 / $12,765.09
| Professional | | $1,161.00 | $2,374.88 | $12,765.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,970.26 / $10,801.75 / $20,277.64
| Facility | | $7,970.26 | $10,801.75 | $20,277.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,678.00 / $4,406.00 / $13,909.00
| Facility | | $3,678.00 | $4,406.00 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |