- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,090.30 / $6,918.31
| Professional | | $2,754.23 | $3,090.30 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,413.10 / $8,912.51
| Professional | | $5,128.61 | $7,413.10 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,677.35 / $6,760.83
| Professional | | $3,630.78 | $4,677.35 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $3,090.30
| Facility | | $1,288.25 | $1,288.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,495.41 / $9,772.37
| Professional | | $3,090.30 | $5,495.41 | $9,772.37 |