- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,517.07 / $10,102.74 / $14,348.82
| Facility | | $9,517.07 | $10,102.74 | $14,348.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,383.10 / $10,102.74 / $14,641.65
| Professional | | $8,383.10 | $10,102.74 | $14,641.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,326.88 / $26,183.66 / $36,804.72
| Facility | | $15,326.88 | $26,183.66 | $36,804.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,452.39 / $12,502.47 / $12,502.47
| Professional | | $10,452.39 | $12,502.47 | $12,502.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,419.15 / $15,419.15 / $15,419.15
| Facility | | $15,419.15 | $15,419.15 | $15,419.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,812.54 / $9,812.54 / $9,812.54
| Facility | | $9,812.54 | $9,812.54 | $9,812.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,340.66 / $9,812.54 / $9,812.54
| Professional | | $8,340.66 | $9,812.54 | $9,812.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,222.91 / $8,869.70 / $12,445.87
| Professional | | $5,222.91 | $8,869.70 | $12,445.87 |