- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,589.66 / $3,831.07
| Professional | | $2,528.00 | $2,589.66 | $3,831.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,397.00 / $8,876.00 / $13,734.00
| Professional | | $7,397.00 | $8,876.00 | $13,734.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,908.79 / $4,690.72 / $6,521.50
| Professional | | $2,908.79 | $4,690.72 | $6,521.50 |
- 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
- $2,942.10 / $5,282.71 / $10,966.54
| Professional | | $2,942.10 | $5,282.71 | $10,966.54 |