- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,532.64 / $8,032.25 / $12,530.30
| Facility | | $7,532.64 | $8,032.25 | $12,530.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,186.75 / $10,040.29 / $21,103.00
| Professional | | $7,186.75 | $10,040.29 | $21,103.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,829.54 / $14,343.91 / $31,117.78
| Facility | | $7,829.54 | $14,343.91 | $31,117.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,024.19 / $6,341.25 / $6,785.14
| Professional | | $6,024.19 | $6,341.25 | $6,785.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,304.76 / $10,304.76 / $12,880.95
| Professional | | $10,304.76 | $10,304.76 | $12,880.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,032.25 / $8,032.25 / $14,759.30
| Facility | | $8,032.25 | $8,032.25 | $14,759.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,116.80 / $8,116.80 / $10,957.68
| Professional | | $8,116.80 | $8,116.80 | $10,957.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,543.50 / $2,205.00 / $3,675.00
| Professional | | $1,543.50 | $2,205.00 | $3,675.00 |