- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,570.88 / $10,715.19
| Professional | | $3,715.35 | $4,570.88 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $6,606.93
| Facility | | $6,606.93 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,495.41 / $12,302.69
| Professional | | $3,630.78 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,244.36 / $7,762.47
| Facility | | $6,309.57 | $7,244.36 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,244.36 / $7,762.47
| Professional | | $6,309.57 | $7,244.36 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,495.41 / $9,772.37
| Facility | | $3,890.45 | $5,495.41 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $6,606.93 / $10,964.78
| Professional | | $79.43 | $6,606.93 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,606.93 / $8,709.64
| Professional | | $5,128.61 | $6,606.93 | $8,709.64 |