- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $28,840.32 / $44,668.36
| Facility | | $15,848.93 | $28,840.32 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,548.13 / $3,715.35
| Professional | | $3,467.37 | $3,548.13 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $10,232.93
| Facility | | $10,232.93 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $17,782.79
| Facility | | $3,715.35 | $3,715.35 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $11,748.98
| Professional | | $3,715.35 | $3,715.35 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $13,489.63 / $14,791.08
| Facility | | $3,715.35 | $13,489.63 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $8,317.64
| Professional | | $8,317.64 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $10,232.93 / $17,782.79
| Facility | | $2,951.21 | $10,232.93 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $7,413.10 / $10,964.78
| Professional | | $2,187.76 | $7,413.10 | $10,964.78 |