- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $10,471.29 / $16,595.87
| Facility | | $1,698.24 | $10,471.29 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $15,488.17 / $15,488.17
| Professional | | $1,698.24 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Professional | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $18,197.01 / $38,018.94
| Facility | | $16,982.44 | $18,197.01 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $21,379.62 / $28,840.32
| Facility | | $9,549.93 | $21,379.62 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70,794.58 / $70,794.58 / $70,794.58
| Facility | | $70,794.58 | $70,794.58 | $70,794.58 |