- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,976.29 / $11,658.10 / $18,804.09
| Facility | | $9,976.29 | $11,658.10 | $18,804.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,270.61 / $9,043.62 / $18,056.07
| Professional | | $6,270.61 | $9,043.62 | $18,056.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,683.50 / $17,683.50 / $17,683.50
| Facility | | $17,683.50 | $17,683.50 | $17,683.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,267.56 / $22,267.56 / $22,267.56
| Professional | | $22,267.56 | $22,267.56 | $22,267.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.40 / $58.40 / $58.40
| Professional | | $58.40 | $58.40 | $58.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,683.50 / $17,683.50 / $17,683.50
| Facility | | $17,683.50 | $17,683.50 | $17,683.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,177.00 / $22,267.56 / $22,267.56
| Professional | | $21,177.00 | $22,267.56 | $22,267.56 |