- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,022.36 / $16,022.36 / $23,447.35
| Facility | | $16,022.36 | $16,022.36 | $23,447.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,022.36 / $23,447.35 / $26,378.27
| Professional | | $16,022.36 | $23,447.35 | $26,378.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,150.18 / $8,150.18 / $8,150.18
| Facility | | $8,150.18 | $8,150.18 | $8,150.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,150.18 / $8,150.18 / $8,150.18
| Professional | | $8,150.18 | $8,150.18 | $8,150.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,608.54 / $16,608.54 / $16,608.54
| Facility | | $16,608.54 | $16,608.54 | $16,608.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,608.54 / $16,608.54 / $16,608.54
| Professional | | $16,608.54 | $16,608.54 | $16,608.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,883.41 / $4,314.91 / $17,259.84
| Professional | | $3,883.41 | $4,314.91 | $17,259.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,631.56 / $16,282.88 / $21,167.74
| Professional | | $15,631.56 | $16,282.88 | $21,167.74 |