- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,058.92 / $2,097.79 / $3,138.32
| Professional | | $2,058.92 | $2,097.79 | $3,138.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,963.00 / $7,156.00 / $11,071.00
| Professional | | $5,963.00 | $7,156.00 | $11,071.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,332.01 / $3,790.33 / $5,343.72
| Professional | | $2,332.01 | $3,790.33 | $5,343.72 |
- 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
- $2,341.77 / $4,271.80 / $8,899.42
| Professional | | $2,341.77 | $4,271.80 | $8,899.42 |