- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $9,739.53 / $21,887.62
| Facility | | $1,456.00 | $9,739.53 | $21,887.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.30 / $673.30 / $673.30
| Professional | | $673.30 | $673.30 | $673.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,628.16 / $31,182.21 / $49,541.83
| Facility | | $19,628.16 | $31,182.21 | $49,541.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,516.00 / $5,516.00 / $15,917.00
| Facility | | $5,516.00 | $5,516.00 | $15,917.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.25 / $362.25 / $362.25
| Professional | | $362.25 | $362.25 | $362.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.30 / $7,223.00 / $25,468.76
| Facility | | $673.30 | $7,223.00 | $25,468.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,960.00 / $10,658.00 / $25,468.76
| Facility | | $1,960.00 | $10,658.00 | $25,468.76 |