- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,228.87 / $18,228.87 / $18,228.87
| Professional | | $18,228.87 | $18,228.87 | $18,228.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,694.63 / $10,694.63 / $10,694.63
| Facility | | $10,694.63 | $10,694.63 | $10,694.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,090.44 / $10,694.63 / $10,694.63
| Professional | | $9,090.44 | $10,694.63 | $10,694.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,554.24 / $9,803.33 / $14,583.10
| Facility | | $6,554.24 | $9,803.33 | $14,583.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,654.02 / $1,654.02 / $1,741.07
| Professional | | $1,654.02 | $1,654.02 | $1,741.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,154.32 / $14,024.90 / $35,062.25
| Professional | | $2,154.32 | $14,024.90 | $35,062.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,554.24 / $10,214.42 / $14,417.38
| Facility | | $6,554.24 | $10,214.42 | $14,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,090.44 / $10,694.63 / $10,694.63
| Professional | | $9,090.44 | $10,694.63 | $10,694.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,790.64 / $11,098.73 / $20,267.25
| Professional | | $5,790.64 | $11,098.73 | $20,267.25 |