- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,405.00 / $5,522.00 / $10,498.50
| Facility | | $2,405.00 | $5,522.00 | $10,498.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,535.50 / $10,895.24 / $10,895.24
| Professional | | $7,535.50 | $10,895.24 | $10,895.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,772.50 / $9,871.00 / $17,678.00
| Facility | | $5,772.50 | $9,871.00 | $17,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.03 / $233.03 / $233.03
| Professional | | $233.03 | $233.03 | $233.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,602.71 / $9,602.71 / $10,511.37
| Facility | | $9,602.71 | $9,602.71 | $10,511.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,873.00 / $10,317.00 / $19,962.00
| Facility | | $4,873.00 | $10,317.00 | $19,962.00 |