- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,700.11 / $5,700.11 / $6,577.05
| Professional | | $5,700.11 | $5,700.11 | $6,577.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,302.44 / $8,302.44 / $8,585.25
| Facility | | $8,302.44 | $8,302.44 | $8,585.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,060.78 / $6,612.09 / $8,551.51
| Professional | | $6,060.78 | $6,612.09 | $8,551.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,302.44 / $8,302.44 / $8,585.25
| Facility | | $8,302.44 | $8,302.44 | $8,585.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,060.78 / $8,302.44 / $8,551.51
| Professional | | $6,060.78 | $8,302.44 | $8,551.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,884.94 / $7,980.36 / $13,503.56
| Professional | | $3,884.94 | $7,980.36 | $13,503.56 |