- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,038.00 / $5,743.00 / $8,802.00
| Facility | | $3,038.00 | $5,743.00 | $8,802.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,992.00 / $2,843.00 / $7,679.00
| Professional | | $1,992.00 | $2,843.00 | $7,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.58 / $356.58 / $356.58
| Professional | | $356.58 | $356.58 | $356.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,568.46 / $33,559.12 / $48,451.20
| Facility | | $26,568.46 | $33,559.12 | $48,451.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $10,927.00 / $24,613.00
| Facility | | $3,340.00 | $10,927.00 | $24,613.00 |