- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,955.04 / $5,496.04
| Facility | | $3,706.14 | $3,955.04 | $5,496.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.75 / $420.06 / $447.55
| Professional | | $242.75 | $420.06 | $447.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,186.76 / $47,491.67 / $51,223.06
| Facility | | $39,186.76 | $47,491.67 | $51,223.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,807.00 / $10,745.00 / $74,646.00
| Facility | | $6,807.00 | $10,745.00 | $74,646.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.06 / $583.28 / $901.28
| Professional | | $431.06 | $583.28 | $901.28 |