- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,889.67 / $2,087.12 / $3,109.73
| Professional | | $1,889.67 | $2,087.12 | $3,109.73 |
- 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
- $2,335.34 / $3,693.53 / $5,047.25
| Professional | | $2,335.34 | $3,693.53 | $5,047.25 |
- 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
- $1,898.89 / $3,976.81 / $7,832.87
| Professional | | $1,898.89 | $3,976.81 | $7,832.87 |