- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.23 / $3,124.38 / $62,872.80
| Professional | | $768.23 | $3,124.38 | $62,872.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,640.79 / $17,723.84 / $23,844.24
| Facility | | $14,640.79 | $17,723.84 | $23,844.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,173.88 / $9,617.57 / $15,113.32
| Professional | | $1,173.88 | $9,617.57 | $15,113.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,111.00 / $5,141.00 / $24,047.74
| Facility | | $5,111.00 | $5,141.00 | $24,047.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,555.31 / $14,475.90 / $22,727.16
| Professional | | $10,555.31 | $14,475.90 | $22,727.16 |