- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,132.66 / $1,141.86 / $1,437.35
| Professional | | $1,132.66 | $1,141.86 | $1,437.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,116.00 / $6,116.00 / $6,116.00
| Facility | | $6,116.00 | $6,116.00 | $6,116.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,177.00 / $2,612.00 / $3,953.00
| Professional | | $2,177.00 | $2,612.00 | $3,953.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,529.36 / $2,283.75 / $3,141.12
| Professional | | $1,529.36 | $2,283.75 | $3,141.12 |
- 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
- $1,828.40 / $2,274.17 / $4,026.08
| Professional | | $1,828.40 | $2,274.17 | $4,026.08 |