- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,490.16 / $6,844.75 / $8,213.70
| Facility | | $4,490.16 | $6,844.75 | $8,213.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,106.85 / $4,490.16 / $4,654.43
| Professional | | $4,106.85 | $4,490.16 | $4,654.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,392.33 / $30,801.38 / $147,846.60
| Facility | | $7,392.33 | $30,801.38 | $147,846.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,570.96 / $7,392.33 / $119,998.80
| Professional | | $6,570.96 | $7,392.33 | $119,998.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,449.09 / $6,570.96 / $16,426.03
| Facility | | $4,449.09 | $6,570.96 | $16,426.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,393.36 / $26,393.36 / $26,393.36
| Professional | | $26,393.36 | $26,393.36 | $26,393.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,299.84 / $2,464.11 / $7,939.91
| Professional | | $2,299.84 | $2,464.11 | $7,939.91 |