- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,076.48 / $1,084.83 / $1,366.14
| Professional | | $1,076.48 | $1,084.83 | $1,366.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,069.00 / $2,483.00 / $3,757.00
| Professional | | $2,069.00 | $2,483.00 | $3,757.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,442.96 / $2,164.44 / $2,986.64
| Professional | | $1,442.96 | $2,164.44 | $2,986.64 |
- 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
- $1,228.78 / $2,157.14 / $3,654.31
| Professional | | $1,228.78 | $2,157.14 | $3,654.31 |