- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $4,838.00 / $11,446.00
| Facility | | $3,248.00 | $4,838.00 | $11,446.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,309.22 / $4,275.50 / $16,534.50
| Facility | | $1,309.22 | $4,275.50 | $16,534.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,309.22 / $1,309.22 / $1,309.22
| Professional | | $1,309.22 | $1,309.22 | $1,309.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,036.34 / $3,637.88 / $4,380.10
| Professional | | $3,036.34 | $3,637.88 | $4,380.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,458.94 / $6,977.41 / $6,977.41
| Professional | | $3,458.94 | $6,977.41 | $6,977.41 |