- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,724.00 / $10,915.56 / $21,899.37
| Facility | | $5,724.00 | $10,915.56 | $21,899.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,295.00 / $1,736.36 / $15,154.57
| Professional | | $1,295.00 | $1,736.36 | $15,154.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,860.00 / $10,338.04 / $19,997.13
| Facility | | $7,860.00 | $10,338.04 | $19,997.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,265.53 / $15,265.53 / $15,265.53
| Facility | | $15,265.53 | $15,265.53 | $15,265.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $9,696.00 / $30,309.14
| Facility | | $100.00 | $9,696.00 | $30,309.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,265.53 / $17,507.09 / $21,008.51
| Facility | | $15,265.53 | $17,507.09 | $21,008.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |