- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,887.37 / $14,978.19 / $14,978.19
| Professional | | $2,887.37 | $14,978.19 | $14,978.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,633.41 / $9,321.81 / $13,253.10
| Professional | | $7,633.41 | $9,321.81 | $13,253.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,887.37 / $14,978.19 / $20,969.47
| Facility | | $2,887.37 | $14,978.19 | $20,969.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,782.69 / $2,782.69 / $3,975.28
| Professional | | $2,782.69 | $2,782.69 | $3,975.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,461.25 / $16,183.75 / $20,584.00
| Professional | | $10,461.25 | $16,183.75 | $20,584.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,999.55 / $14,978.19 / $20,969.47
| Facility | | $3,999.55 | $14,978.19 | $20,969.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,276.75 / $14,645.75 / $18,411.80
| Professional | | $6,276.75 | $14,645.75 | $18,411.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,201.60 / $14,352.80 / $18,043.52
| Professional | | $8,201.60 | $14,352.80 | $18,043.52 |