- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,256.33 / $1,288.71 / $1,913.26
| Professional | | $1,256.33 | $1,288.71 | $1,913.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,684.00 / $4,421.00 / $6,840.00
| Professional | | $3,684.00 | $4,421.00 | $6,840.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.55 / $2,340.17 / $3,341.30
| Professional | | $1,445.55 | $2,340.17 | $3,341.30 |
- 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
- $1,449.58 / $2,615.06 / $5,438.40
| Professional | | $1,449.58 | $2,615.06 | $5,438.40 |