- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,279.39 / $1,898.14 / $2,202.57
| Professional | | $1,279.39 | $1,898.14 | $2,202.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,090.00 / $7,090.00 / $7,090.00
| Professional | | $7,090.00 | $7,090.00 | $7,090.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,274.00 / $1,274.00 / $1,349.24
| Facility | | $1,274.00 | $1,274.00 | $1,349.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,865.23 / $2,131.69 / $2,975.71
| Professional | | $1,865.23 | $2,131.69 | $2,975.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,080.00 / $12,080.00 / $12,080.00
| Facility | | $12,080.00 | $12,080.00 | $12,080.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,297.79 / $1,829.76 / $3,945.28
| Professional | | $1,297.79 | $1,829.76 | $3,945.28 |