- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,452.15 / $12,449.88 / $12,884.17
| Professional | | $9,452.15 | $12,449.88 | $12,884.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,732.63 / $7,318.08 / $7,318.08
| Professional | | $6,732.63 | $7,318.08 | $7,318.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,694.63 / $10,694.63 / $11,324.00
| Facility | | $10,694.63 | $10,694.63 | $11,324.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.51 / $10,694.63 / $20,182.50
| Professional | | $1,230.51 | $10,694.63 | $20,182.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,336.53 / $5,510.36 / $9,115.60
| Professional | | $3,336.53 | $5,510.36 | $9,115.60 |