- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,799.18 / $10,057.12 / $10,379.20
| Facility | | $6,799.18 | $10,057.12 | $10,379.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,799.18 / $7,790.73 / $14,164.96
| Professional | | $6,799.18 | $7,790.73 | $14,164.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,882.05 / $15,626.15 / $68,695.53
| Facility | | $14,882.05 | $15,626.15 | $68,695.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,779.45 / $8,832.85 / $12,040.22
| Professional | | $7,779.45 | $8,832.85 | $12,040.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,907.40 / $9,907.40 / $9,907.40
| Facility | | $9,907.40 | $9,907.40 | $9,907.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,232.40 / $7,232.40 / $10,204.62
| Professional | | $7,232.40 | $7,232.40 | $10,204.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,919.46 / $12,085.86 / $75,302.32
| Facility | | $6,919.46 | $12,085.86 | $75,302.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,010.80 / $8,043.20 / $13,529.62
| Professional | | $6,010.80 | $8,043.20 | $13,529.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,010.80 / $7,480.91 / $11,114.95
| Professional | | $6,010.80 | $7,480.91 | $11,114.95 |