- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,772.85 / $2,820.63 / $3,529.64
| Professional | | $2,772.85 | $2,820.63 | $3,529.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,360.00 / $6,432.00 / $9,730.00
| Professional | | $5,360.00 | $6,432.00 | $9,730.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,874.55 / $5,641.26 / $7,692.00
| Professional | | $3,874.55 | $5,641.26 | $7,692.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,934.00 / $6,934.00 / $26,502.00
| Facility | | $6,934.00 | $6,934.00 | $26,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,120.58 / $5,697.61 / $9,652.48
| Professional | | $3,120.58 | $5,697.61 | $9,652.48 |