- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,554.24 / $10,214.42 / $10,519.33
| Professional | | $6,554.24 | $10,214.42 | $10,519.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,594.48 / $9,154.96 / $10,671.78
| Professional | | $6,594.48 | $9,154.96 | $10,671.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,694.63 / $10,694.63 / $10,694.63
| Facility | | $10,694.63 | $10,694.63 | $10,694.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.51 / $10,694.63 / $20,182.50
| Professional | | $1,230.51 | $10,694.63 | $20,182.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,741.07 / $1,741.07 / $1,741.07
| Professional | | $1,741.07 | $1,741.07 | $1,741.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,336.53 / $4,922.04 / $8,203.40
| Professional | | $3,336.53 | $4,922.04 | $8,203.40 |