- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,073.49 / $5,602.74 / $10,039.45
| Professional | | $3,073.49 | $5,602.74 | $10,039.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,447.14 / $7,447.14 / $7,447.14
| Facility | | $7,447.14 | $7,447.14 | $7,447.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,330.07 / $7,447.14 / $14,055.00
| Professional | | $6,330.07 | $7,447.14 | $14,055.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,064.56 / $8,064.56 / $8,064.56
| Professional | | $8,064.56 | $8,064.56 | $8,064.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,233.01 / $4,032.28 / $7,420.16
| Professional | | $3,233.01 | $4,032.28 | $7,420.16 |