- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,862.20 / $13,403.10 / $30,454.70
| Facility | | $10,862.20 | $13,403.10 | $30,454.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,121.26 / $8,425.81 / $9,867.34
| Professional | | $8,121.26 | $8,425.81 | $9,867.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,309.14 / $26,952.44 / $47,737.79
| Facility | | $7,309.14 | $26,952.44 | $47,737.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,106.11 / $8,121.26 / $9,136.42
| Professional | | $7,106.11 | $8,121.26 | $9,136.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,304.94 / $8,628.84 / $8,628.84
| Facility | | $8,304.94 | $8,628.84 | $8,628.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,628.84 / $8,628.84 / $8,628.84
| Professional | | $8,628.84 | $8,628.84 | $8,628.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.55 / $8,222.78 / $12,181.89
| Facility | | $368.55 | $8,222.78 | $12,181.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,459.66 / $8,459.66 / $37,127.98
| Professional | | $8,459.66 | $8,459.66 | $37,127.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,459.66 / $8,459.66 / $8,967.24
| Professional | | $8,459.66 | $8,459.66 | $8,967.24 |