- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,928.93 / $11,760.76 / $12,171.02
| Professional | | $8,928.93 | $11,760.76 | $12,171.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,359.99 / $6,913.03 / $6,913.03
| Professional | | $6,359.99 | $6,913.03 | $6,913.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,102.62 / $10,102.62 / $10,697.17
| Facility | | $10,102.62 | $10,102.62 | $10,697.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,162.40 / $10,102.62 / $19,068.75
| Professional | | $1,162.40 | $10,102.62 | $19,068.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,151.84 / $5,356.07 / $8,525.29
| Professional | | $3,151.84 | $5,356.07 | $8,525.29 |