- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,262.02 / $10,900.00 / $14,552.94
| Facility | | $6,262.02 | $10,900.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,096.20 / $12,027.52 / $12,027.52
| Professional | | $11,096.20 | $12,027.52 | $12,027.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,349.16 / $7,349.16 / $7,349.16
| Professional | | $7,349.16 | $7,349.16 | $7,349.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,633.71 / $12,027.52 / $17,199.34
| Facility | | $2,633.71 | $12,027.52 | $17,199.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,208.60 / $13,526.10 / $17,273.43
| Professional | | $5,208.60 | $13,526.10 | $17,273.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,051.25 / $9,339.45 / $14,113.67
| Professional | | $8,051.25 | $9,339.45 | $14,113.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,633.71 / $12,027.52 / $17,199.34
| Facility | | $2,633.71 | $12,027.52 | $17,199.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,104.39 / $9,460.50 / $14,445.77
| Professional | | $2,104.39 | $9,460.50 | $14,445.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,879.34 / $8,819.01 / $13,567.10
| Professional | | $5,879.34 | $8,819.01 | $13,567.10 |