- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,138.48 / $3,972.91 / $4,476.84
| Professional | | $3,138.48 | $3,972.91 | $4,476.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,526.30 / $5,526.30 / $5,526.30
| Professional | | $5,526.30 | $5,526.30 | $5,526.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.57 / $775.57 / $4,321.80
| Facility | | $775.57 | $775.57 | $4,321.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,673.53 / $3,673.53 / $3,673.53
| Professional | | $3,673.53 | $3,673.53 | $3,673.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,231.84 / $3,407.76 / $5,679.60
| Professional | | $2,231.84 | $3,407.76 | $5,679.60 |