- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,079.46 / $11,481.54
| Facility | | $2,884.03 | $7,079.46 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $9,332.54 / $15,848.93
| Professional | | $1,737.80 | $9,332.54 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $22,387.21 / $38,018.94
| Facility | | $12,882.50 | $22,387.21 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.02
| Professional | | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,589.25 / $18,197.01 / $22,387.21
| Professional | | $12,589.25 | $18,197.01 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $22,908.68 / $22,908.68
| Facility | | $22,908.68 | $22,908.68 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $15,135.61 / $30,199.52
| Facility | | $10,000.00 | $15,135.61 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $15,135.61 / $30,199.52
| Professional | | $10,000.00 | $15,135.61 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $18,620.87 / $40,738.03
| Facility | | $10,964.78 | $18,620.87 | $40,738.03 |