- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,257.67 / $3,441.56 / $4,129.88
| Facility | | $2,257.67 | $3,441.56 | $4,129.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,064.94 / $2,202.60 / $2,257.67
| Professional | | $2,064.94 | $2,202.60 | $2,257.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,716.89 / $15,487.03 / $74,337.75
| Facility | | $3,716.89 | $15,487.03 | $74,337.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,303.90 / $3,716.89 / $119,998.80
| Professional | | $3,303.90 | $3,716.89 | $119,998.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,237.01 / $3,303.90 / $8,259.04
| Facility | | $2,237.01 | $3,303.90 | $8,259.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,270.67 / $13,270.67 / $13,270.67
| Professional | | $13,270.67 | $13,270.67 | $13,270.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,156.36 / $1,376.63 / $3,992.21
| Professional | | $1,156.36 | $1,376.63 | $3,992.21 |