- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,071.52 / $2,344.23
| Professional | | $933.25 | $1,071.52 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,511.89 / $2,951.21
| Professional | | $2,187.76 | $2,511.89 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $2,290.87
| Professional | | $1,348.96 | $1,348.96 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $29,512.09
| Facility | | $12,589.25 | $12,589.25 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,862.09 / $3,630.78
| Professional | | $1,174.90 | $1,862.09 | $3,630.78 |