- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,176.58 / $1,212.89 / $1,746.92
| Professional | | $1,176.58 | $1,212.89 | $1,746.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,367.00 / $4,040.00 / $6,251.00
| Professional | | $3,367.00 | $4,040.00 | $6,251.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.44 / $2,140.63 / $3,065.09
| Professional | | $1,319.44 | $2,140.63 | $3,065.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $3,239.00
| Facility | | $1,275.00 | $1,275.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,254.72 / $2,274.17 / $4,692.99
| Professional | | $1,254.72 | $2,274.17 | $4,692.99 |