- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,258.82 / $5,996.70 / $6,573.53
| Professional | | $5,258.82 | $5,996.70 | $6,573.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.03 / $684.28 / $7,691.03
| Facility | | $648.03 | $684.28 | $7,691.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.03 / $736.92 / $8,282.65
| Professional | | $648.03 | $736.92 | $8,282.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,933.43 / $4,933.43 / $11,465.32
| Facility | | $4,933.43 | $4,933.43 | $11,465.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.57 / $4,933.43 / $6,993.18
| Professional | | $783.57 | $4,933.43 | $6,993.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,586.02 / $6,586.02 / $6,586.02
| Professional | | $6,586.02 | $6,586.02 | $6,586.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $623.65 / $5,001.30 / $7,918.73
| Facility | | $623.65 | $5,001.30 | $7,918.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,291.25 / $5,845.85 / $8,742.04
| Professional | | $4,291.25 | $5,845.85 | $8,742.04 |