- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,488.00 / $11,009.00 / $16,613.00
| Facility | | $10,488.00 | $11,009.00 | $16,613.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,843.00 / $2,843.00 / $2,843.00
| Professional | | $2,843.00 | $2,843.00 | $2,843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,892.30 / $42,318.71 / $74,202.12
| Facility | | $27,892.30 | $42,318.71 | $74,202.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,913.00 / $13,757.00 / $57,897.36
| Facility | | $5,913.00 | $13,757.00 | $57,897.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,891.00 / $13,757.00 / $32,027.00
| Facility | | $5,891.00 | $13,757.00 | $32,027.00 |