- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,165.95 / $17,378.01
| Professional | | $4,897.79 | $6,165.95 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $22,387.21 / $26,302.68
| Facility | | $16,595.87 | $22,387.21 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $6,025.60 / $12,022.64
| Professional | | $4,466.84 | $6,025.60 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $8,128.31
| Facility | | $5,754.40 | $5,754.40 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $8,128.31
| Professional | | $5,888.44 | $5,888.44 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,128.31 / $14,454.40
| Facility | | $6,918.31 | $8,128.31 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $6,606.93 / $9,549.93
| Professional | | $5,248.07 | $6,606.93 | $9,549.93 |