- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,162.54 / $3,038.00 / $4,387.00
| Facility | | $2,162.54 | $3,038.00 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,140.38 / $2,162.54 / $2,162.54
| Professional | | $2,140.38 | $2,162.54 | $2,162.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $60.00
| Professional | | $45.00 | $45.00 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,605.91 / $1,993.67 / $7,232.95
| Professional | | $1,605.91 | $1,993.67 | $7,232.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,312.00 / $2,446.00 / $13,847.00
| Facility | | $2,312.00 | $2,446.00 | $13,847.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,098.91 / $1,407.49 / $2,893.62
| Professional | | $1,098.91 | $1,407.49 | $2,893.62 |