- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,630.65 / $1,672.55 / $2,054.76
| Professional | | $1,630.65 | $1,672.55 | $2,054.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,426.00 / $4,111.00 / $6,618.00
| Professional | | $3,426.00 | $4,111.00 | $6,618.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,025.95 / $3,078.16 / $4,174.22
| Professional | | $2,025.95 | $3,078.16 | $4,174.22 |
- 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
- $2,340.73 / $3,327.32 / $5,415.81
| Professional | | $2,340.73 | $3,327.32 | $5,415.81 |