- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,038.00 / $5,743.00 / $11,471.00
| Facility | | $3,038.00 | $5,743.00 | $11,471.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,843.00 / $3,216.00 / $8,763.00
| Professional | | $2,843.00 | $3,216.00 | $8,763.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,834.02 / $12,032.05 / $20,146.98
| Facility | | $9,834.02 | $12,032.05 | $20,146.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,616.70 / $20,988.87 / $30,397.25
| Facility | | $16,616.70 | $20,988.87 | $30,397.25 |
- 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 |