- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,471.29 / $28,840.32
| Professional | | $8,912.51 | $10,471.29 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,199.52 / $40,738.03 / $47,863.01
| Facility | | $30,199.52 | $40,738.03 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,317.64 / $11,220.18 / $21,877.62
| Professional | | $8,317.64 | $11,220.18 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $12,882.50 / $12,882.50
| Facility | | $12,882.50 | $12,882.50 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $12,882.50
| Professional | | $9,332.54 | $9,332.54 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $14,454.40 / $25,703.96
| Facility | | $12,302.69 | $14,454.40 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $12,302.69 / $17,378.01
| Professional | | $9,332.54 | $12,302.69 | $17,378.01 |