- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $12,022.64 / $18,197.01
| Facility | | $9,120.11 | $12,022.64 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $9,120.11 / $17,378.01
| Professional | | $9,120.11 | $9,120.11 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $10,232.93 / $17,782.79
| Facility | | $4,365.16 | $10,232.93 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $16,595.87 / $19,054.61
| Facility | | $11,748.98 | $16,595.87 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $22,387.21 / $37,153.52
| Facility | | $8,317.64 | $22,387.21 | $37,153.52 |