- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,079.46 / $8,912.51
| Professional | | $5,248.07 | $7,079.46 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $6,165.95
| Facility | | $5,128.61 | $5,128.61 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,128.61 / $14,791.08
| Professional | | $4,365.16 | $5,128.61 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,413.10 / $9,120.11
| Facility | | $5,754.40 | $7,413.10 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Professional | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $2,238.72 / $4,168.69
| Professional | | $309.03 | $2,238.72 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $851.14 / $5,495.41
| Facility | | $630.96 | $851.14 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,801.89 / $5,248.07
| Professional | | $2,691.53 | $3,801.89 | $5,248.07 |