- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $892.94 / $8,711.31 / $10,124.45
| Professional | | $892.94 | $8,711.31 | $10,124.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.10 / $768.13 / $975.53
| Professional | | $511.10 | $768.13 | $975.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,160.75 / $12,160.75 / $12,160.75
| Facility | | $12,160.75 | $12,160.75 | $12,160.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,333.55 / $14,615.65 / $17,404.15
| Professional | | $11,333.55 | $14,615.65 | $17,404.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.12 / $806.21 / $1,564.05
| Professional | | $484.12 | $806.21 | $1,564.05 |