- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $569.37 / $1,821.00 / $9,477.00
| Facility | | $569.37 | $1,821.00 | $9,477.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.37 / $569.37 / $1,046.06
| Professional | | $569.37 | $569.37 | $1,046.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,063.64 / $4,063.64 / $4,876.37
| Facility | | $4,063.64 | $4,063.64 | $4,876.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.37 / $1,046.08 / $1,162.31
| Professional | | $790.37 | $1,046.08 | $1,162.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.00 / $3,709.00 / $7,643.43
| Facility | | $1,565.00 | $3,709.00 | $7,643.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $826.36 / $1,135.79 / $1,603.98
| Professional | | $826.36 | $1,135.79 | $1,603.98 |