- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,940.42 / $4,396.00 / $10,300.00
| Facility | | $1,940.42 | $4,396.00 | $10,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,996.00 / $8,455.00 / $16,907.36
| Facility | | $6,996.00 | $8,455.00 | $16,907.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,182.00 / $15,182.00 / $15,182.00
| Facility | | $15,182.00 | $15,182.00 | $15,182.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.40 / $1,947.97 / $3,099.04
| Professional | | $30.40 | $1,947.97 | $3,099.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,163.00 / $6,491.00 / $14,434.00
| Facility | | $3,163.00 | $6,491.00 | $14,434.00 |