- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.21 / $3,079.48 / $61,857.80
| Professional | | $962.21 | $3,079.48 | $61,857.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.35 / $576.35 / $7,429.83
| Professional | | $576.35 | $576.35 | $7,429.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,829.73 / $21,752.12 / $38,059.43
| Facility | | $11,829.73 | $21,752.12 | $38,059.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.19 / $1,225.83 / $14,567.00
| Professional | | $820.19 | $1,225.83 | $14,567.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,052.11 / $14,399.43 / $23,060.46
| Professional | | $10,052.11 | $14,399.43 | $23,060.46 |