- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,477.75 / $11,373.30 / $11,373.30
| Facility | | $9,477.75 | $11,373.30 | $11,373.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,235.96 / $42,649.88 / $204,719.40
| Facility | | $10,235.96 | $42,649.88 | $204,719.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,098.64 / $10,235.96 / $119,998.80
| Professional | | $9,098.64 | $10,235.96 | $119,998.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,160.54 / $9,098.64 / $22,744.70
| Facility | | $6,160.54 | $9,098.64 | $22,744.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,546.19 / $36,546.19 / $36,546.19
| Professional | | $36,546.19 | $36,546.19 | $36,546.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,184.52 / $3,791.10 / $10,994.19
| Professional | | $3,184.52 | $3,791.10 | $10,994.19 |