- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,592.79 / $1,613.96 / $2,023.64
| Professional | | $1,592.79 | $1,613.96 | $2,023.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,072.00 / $3,686.00 / $5,576.00
| Professional | | $3,072.00 | $3,686.00 | $5,576.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,107.08 / $3,160.62 / $4,416.39
| Professional | | $2,107.08 | $3,160.62 | $4,416.39 |
- 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
- $2,284.38 / $3,247.23 / $5,405.41
| Professional | | $2,284.38 | $3,247.23 | $5,405.41 |