- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,164.08 / $9,164.08 / $23,529.40
| Facility | | $9,164.08 | $9,164.08 | $23,529.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,164.08 / $12,728.48 / $23,529.40
| Professional | | $9,164.08 | $12,728.48 | $23,529.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,285.52 / $28,285.52 / $28,285.52
| Facility | | $28,285.52 | $28,285.52 | $28,285.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,411.83 / $17,411.83 / $34,568.35
| Professional | | $17,411.83 | $17,411.83 | $34,568.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,200.25 / $16,200.25 / $20,823.14
| Facility | | $16,200.25 | $16,200.25 | $20,823.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,826.18 / $16,200.25 / $18,997.30
| Professional | | $11,826.18 | $16,200.25 | $18,997.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,729.25 / $22,628.42 / $36,771.18
| Professional | | $15,729.25 | $22,628.42 | $36,771.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,958.85 / $12,934.33 / $19,488.06
| Professional | | $11,958.85 | $12,934.33 | $19,488.06 |