- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,577.03 / $1,604.95 / $2,032.52
| Professional | | $1,577.03 | $1,604.95 | $2,032.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,767.20 / $2,767.20 / $2,767.20
| Facility | | $2,767.20 | $2,767.20 | $2,767.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,062.00 / $3,674.00 / $5,558.00
| Professional | | $3,062.00 | $3,674.00 | $5,558.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,161.77 / $3,209.90 / $4,421.41
| Professional | | $2,161.77 | $3,209.90 | $4,421.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,188.00 / $5,188.00 / $18,767.00
| Facility | | $5,188.00 | $5,188.00 | $18,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,504.04 / $2,838.36 / $5,145.39
| Professional | | $1,504.04 | $2,838.36 | $5,145.39 |