- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,226.05 / $41,156.18 / $55,391.78
| Facility | | $18,226.05 | $41,156.18 | $55,391.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,630.18 / $11,668.86 / $22,958.22
| Professional | | $1,630.18 | $11,668.86 | $22,958.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,400.00 / $48,407.50 / $87,518.75
| Facility | | $13,400.00 | $48,407.50 | $87,518.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,050.00 / $13,400.00 / $18,257.50
| Professional | | $10,050.00 | $13,400.00 | $18,257.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,630.18 / $1,630.18 / $15,997.62
| Facility | | $1,630.18 | $1,630.18 | $15,997.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,997.62 / $15,997.62 / $15,997.62
| Professional | | $15,997.62 | $15,997.62 | $15,997.62 |