- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,928.93 / $9,862.27 / $12,817.34
| Professional | | $8,928.93 | $9,862.27 | $12,817.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,735.46 / $1,735.46 / $1,735.46
| Facility | | $1,735.46 | $1,735.46 | $1,735.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,284.91 / $1,284.91 / $1,284.91
| Professional | | $1,284.91 | $1,284.91 | $1,284.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,102.62 / $10,102.62 / $10,697.17
| Facility | | $10,102.62 | $10,102.62 | $10,697.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,162.40 / $10,102.62 / $10,102.62
| Professional | | $1,162.40 | $10,102.62 | $10,102.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,099.73 / $5,424.53 / $8,981.70
| Professional | | $3,099.73 | $5,424.53 | $8,981.70 |