- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $8,317.64 / $12,589.25
| Professional | | $5,495.41 | $8,317.64 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $8,128.31
| Facility | | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,128.31 / $8,128.31
| Professional | | $6,918.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $741.31 / $4,897.79
| Facility | | $645.65 | $741.31 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,981.07 / $7,244.36
| Professional | | $2,884.03 | $3,981.07 | $7,244.36 |