- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,590.11 / $1,631.11 / $2,419.81
| Professional | | $1,590.11 | $1,631.11 | $2,419.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,656.00 / $5,587.00 / $8,645.00
| Professional | | $4,656.00 | $5,587.00 | $8,645.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,829.02 / $2,955.42 / $4,203.50
| Professional | | $1,829.02 | $2,955.42 | $4,203.50 |
- 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
- $1,839.21 / $3,318.57 / $6,890.39
| Professional | | $1,839.21 | $3,318.57 | $6,890.39 |