- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,642.65 / $4,777.33 / $17,744.90
| Professional | | $3,642.65 | $4,777.33 | $17,744.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.52 / $5,370.52 / $5,370.52
| Facility | | $5,370.52 | $5,370.52 | $5,370.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,366.52 / $4,722.35 / $5,370.52
| Professional | | $2,366.52 | $4,722.35 | $5,370.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,645.84 / $3,638.03 / $5,225.72
| Facility | | $2,645.84 | $3,638.03 | $5,225.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,280.61 / $5,057.50 / $7,098.70
| Professional | | $3,280.61 | $5,057.50 | $7,098.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,572.01 / $5,500.87 / $6,286.70
| Professional | | $3,572.01 | $5,500.87 | $6,286.70 |