- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $915.59 / $938.53 / $1,196.83
| Professional | | $915.59 | $938.53 | $1,196.83 |
- 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
- $1,758.00 / $2,110.00 / $3,192.00
| Professional | | $1,758.00 | $2,110.00 | $3,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.81 / $1,700.71 / $2,569.30
| Professional | | $1,133.81 | $1,700.71 | $2,569.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,200.00 / $4,200.00 / $14,634.00
| Facility | | $4,200.00 | $4,200.00 | $14,634.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $971.91 / $1,737.14 / $2,847.01
| Professional | | $971.91 | $1,737.14 | $2,847.01 |