- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,719.35 / $6,719.35 / $8,376.29
| Professional | | $6,719.35 | $6,719.35 | $8,376.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,878.00 / $2,254.00 / $3,289.00
| Professional | | $1,878.00 | $2,254.00 | $3,289.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,238.30 / $1,747.69 / $2,252.98
| Professional | | $1,238.30 | $1,747.69 | $2,252.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,188.00 / $11,831.32 / $18,767.00
| Facility | | $5,188.00 | $11,831.32 | $18,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,410.20 / $2,820.40 / $3,868.91
| Professional | | $1,410.20 | $2,820.40 | $3,868.91 |