- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,134.90 / $7,880.73 / $10,242.03
| Professional | | $7,134.90 | $7,880.73 | $10,242.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.76 / $1,386.76 / $1,386.76
| Facility | | $1,386.76 | $1,386.76 | $1,386.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,026.74 / $1,026.74 / $1,026.74
| Professional | | $1,026.74 | $1,026.74 | $1,026.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,351.96 / $8,072.81 / $8,547.89
| Facility | | $6,351.96 | $8,072.81 | $8,547.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.85 / $8,072.81 / $8,072.81
| Professional | | $928.85 | $8,072.81 | $8,072.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,476.92 / $4,124.77 / $8,460.68
| Professional | | $2,476.92 | $4,124.77 | $8,460.68 |