- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.01 / $1,313.52 / $1,659.17
| Professional | | $1,291.01 | $1,313.52 | $1,659.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,694.40 / $5,694.40 / $5,694.40
| Facility | | $5,694.40 | $5,694.40 | $5,694.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,668.00 / $3,202.00 / $5,153.00
| Professional | | $2,668.00 | $3,202.00 | $5,153.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,638.10 / $2,668.76 / $3,306.68
| Professional | | $1,638.10 | $2,668.76 | $3,306.68 |
- 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
- $1,466.05 / $2,674.67 / $4,525.31
| Professional | | $1,466.05 | $2,674.67 | $4,525.31 |