- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,821.91 / $27,385.59 / $43,188.00
| Facility | | $15,821.91 | $27,385.59 | $43,188.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,126.71 / $15,821.91 / $19,968.25
| Professional | | $14,126.71 | $15,821.91 | $19,968.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,667.56 / $42,032.92 / $65,267.79
| Facility | | $26,667.56 | $42,032.92 | $65,267.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,087.50 / $16,087.50 / $16,087.50
| Professional | | $16,087.50 | $16,087.50 | $16,087.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,126.71 / $15,821.91 / $36,864.83
| Facility | | $14,126.71 | $15,821.91 | $36,864.83 |