- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,285.00 / $10,900.00 / $14,552.94
| Facility | | $9,285.00 | $10,900.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,249.06 / $2,249.06 / $2,249.06
| Professional | | $2,249.06 | $2,249.06 | $2,249.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,249.06 / $2,524.08 / $3,216.16
| Facility | | $2,249.06 | $2,524.08 | $3,216.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,711.25 / $7,785.05 / $11,442.00
| Professional | | $6,711.25 | $7,785.05 | $11,442.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,249.06 / $2,524.08 / $3,216.16
| Facility | | $2,249.06 | $2,524.08 | $3,216.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,028.90 / $7,632.00 / $13,615.98
| Professional | | $3,028.90 | $7,632.00 | $13,615.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,870.58 / $7,305.87 / $12,320.78
| Professional | | $4,870.58 | $7,305.87 | $12,320.78 |