- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,426.95 / $4,870.72 / $6,602.82
| Professional | | $4,426.95 | $4,870.72 | $6,602.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,726.00 / $15,271.00 / $23,627.00
| Professional | | $12,726.00 | $15,271.00 | $23,627.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,013.16 / $8,061.17 / $11,664.48
| Professional | | $5,013.16 | $8,061.17 | $11,664.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $3,239.00
| Facility | | $1,275.00 | $1,275.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,181.08 / $9,110.45 / $19,083.25
| Professional | | $5,181.08 | $9,110.45 | $19,083.25 |