- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $6,086.00 / $11,901.00
| Facility | | $1,924.00 | $6,086.00 | $11,901.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,028.12 / $18,028.12 / $18,028.12
| Professional | | $18,028.12 | $18,028.12 | $18,028.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.00 / $13,071.31 / $15,561.08
| Facility | | $323.00 | $13,071.31 | $15,561.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,187.12 / $4,829.14 / $10,380.00
| Facility | | $4,187.12 | $4,829.14 | $10,380.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,368.00 / $15,379.00 / $31,158.00
| Facility | | $7,368.00 | $15,379.00 | $31,158.00 |