- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,904.75 / $3,873.00 / $9,295.20
| Facility | | $2,904.75 | $3,873.00 | $9,295.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,866.02 / $3,253.32 / $3,873.00
| Professional | | $2,866.02 | $3,253.32 | $3,873.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,679.35 / $3,679.35 / $3,679.35
| Professional | | $3,679.35 | $3,679.35 | $3,679.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,517.44 / $2,517.44 / $10,346.71
| Facility | | $2,517.44 | $2,517.44 | $10,346.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,717.52 / $4,717.52 / $5,652.12
| Professional | | $4,717.52 | $4,717.52 | $5,652.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,866.02 / $3,873.00 / $6,506.64
| Facility | | $2,866.02 | $3,873.00 | $6,506.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.66 / $1,626.66 / $5,809.50
| Professional | | $1,626.66 | $1,626.66 | $5,809.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.66 / $1,626.66 / $2,478.71
| Professional | | $1,626.66 | $1,626.66 | $2,478.71 |