- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.23 / $5,841.00 / $10,692.00
| Facility | | $2,426.23 | $5,841.00 | $10,692.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,286.00 / $6,153.00 / $11,298.00
| Professional | | $2,286.00 | $6,153.00 | $11,298.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,249.45 / $55,249.45 / $55,249.45
| Professional | | $55,249.45 | $55,249.45 | $55,249.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,532.15 / $9,309.76 / $17,754.61
| Facility | | $8,532.15 | $9,309.76 | $17,754.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,415.00 / $7,250.00 / $10,536.00
| Facility | | $4,415.00 | $7,250.00 | $10,536.00 |