- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,950.31 / $1,961.87 / $2,430.29
| Professional | | $1,950.31 | $1,961.87 | $2,430.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,827.00 / $4,592.00 / $6,947.00
| Professional | | $3,827.00 | $4,592.00 | $6,947.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,586.00 / $3,815.28 / $5,402.06
| Professional | | $2,586.00 | $3,815.28 | $5,402.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,509.00 / $8,509.00 / $27,952.00
| Facility | | $8,509.00 | $8,509.00 | $27,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,197.17 / $3,934.69 / $6,550.71
| Professional | | $2,197.17 | $3,934.69 | $6,550.71 |