- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,370.32 / $14,125.38
| Professional | | $4,466.84 | $5,370.32 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,606.93 / $14,454.40
| Professional | | $4,570.88 | $6,606.93 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $9,332.54
| Facility | | $8,317.64 | $8,317.64 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $9,332.54
| Professional | | $8,317.64 | $8,317.64 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $6,606.93 / $12,022.64
| Facility | | $4,466.84 | $6,606.93 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $7,762.47 / $12,589.25
| Professional | | $79.43 | $7,762.47 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,128.31 / $10,232.93
| Professional | | $6,456.54 | $8,128.31 | $10,232.93 |