- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,677.35 / $6,309.57
| Professional | | $4,168.69 | $4,677.35 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,302.69 / $19,054.61 / $22,908.68
| Professional | | $12,302.69 | $19,054.61 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $7,762.47 / $14,791.08
| Professional | | $4,786.30 | $7,762.47 | $14,791.08 |
- 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
- $4,786.30 / $7,943.28 / $16,218.10
| Professional | | $4,786.30 | $7,943.28 | $16,218.10 |