- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,614.00 / $4,392.00
| Facility | | $756.00 | $2,614.00 | $4,392.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,869.16 / $2,605.61 / $2,970.40
| Professional | | $1,869.16 | $2,605.61 | $2,970.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,106.02 / $6,818.55 / $9,769.53
| Facility | | $3,106.02 | $6,818.55 | $9,769.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,585.00
| Facility | | $746.00 | $2,415.00 | $6,585.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,274.33 / $3,142.24 / $5,292.03
| Professional | | $2,274.33 | $3,142.24 | $5,292.03 |