- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,527.01 / $2,527.01 / $8,500.00
| Facility | | $2,527.01 | $2,527.01 | $8,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,527.01 / $2,527.01 / $2,630.72
| Professional | | $2,527.01 | $2,527.01 | $2,630.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,934.60 / $5,358.75 / $6,331.40
| Professional | | $4,934.60 | $5,358.75 | $6,331.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,112.66 / $4,537.89 / $7,325.05
| Professional | | $3,112.66 | $4,537.89 | $7,325.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,527.01 / $3,463.68 / $7,581.03
| Facility | | $2,527.01 | $3,463.68 | $7,581.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,575.21 / $4,800.82 / $6,473.82
| Professional | | $2,575.21 | $4,800.82 | $6,473.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,812.36 / $4,833.68 / $6,473.82
| Professional | | $2,812.36 | $4,833.68 | $6,473.82 |