- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,702.57 / $11,702.57 / $18,285.25
| Facility | | $11,702.57 | $11,702.57 | $18,285.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,985.21 / $17,014.40 / $18,285.25
| Professional | | $10,985.21 | $17,014.40 | $18,285.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,876.08 / $19,876.08 / $19,876.08
| Facility | | $19,876.08 | $19,876.08 | $19,876.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,876.08 / $19,876.08 / $19,876.08
| Professional | | $19,876.08 | $19,876.08 | $19,876.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,752.32 / $12,752.32 / $12,752.32
| Facility | | $12,752.32 | $12,752.32 | $12,752.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,309.19 / $9,309.19 / $12,752.32
| Professional | | $9,309.19 | $9,309.19 | $12,752.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,259.28 / $10,417.94 / $15,693.16
| Professional | | $6,259.28 | $10,417.94 | $15,693.16 |