- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,452.15 / $10,440.17 / $13,568.41
| Professional | | $9,452.15 | $10,440.17 | $13,568.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,837.13 / $1,837.13 / $1,837.13
| Facility | | $1,837.13 | $1,837.13 | $1,837.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.21 / $1,360.21 / $1,360.21
| Professional | | $1,360.21 | $1,360.21 | $1,360.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,922.50 / $10,694.63 / $11,324.00
| Facility | | $6,922.50 | $10,694.63 | $11,324.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.51 / $10,694.63 / $10,694.63
| Professional | | $1,230.51 | $10,694.63 | $10,694.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,281.36 / $5,464.43 / $9,507.95
| Professional | | $3,281.36 | $5,464.43 | $9,507.95 |