- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,596.13 / $1,647.53 / $2,442.92
| Professional | | $1,596.13 | $1,647.53 | $2,442.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,707.00 / $5,648.00 / $8,738.00
| Professional | | $4,707.00 | $5,648.00 | $8,738.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,847.23 / $2,988.93 / $4,180.81
| Professional | | $1,847.23 | $2,988.93 | $4,180.81 |
- 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
- $1,844.50 / $3,321.30 / $6,922.07
| Professional | | $1,844.50 | $3,321.30 | $6,922.07 |