- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $2,720.18 / $4,208.78
| Facility | | $1,400.00 | $2,720.18 | $4,208.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,654.79 / $2,825.13 / $4,147.55
| Professional | | $2,654.79 | $2,825.13 | $4,147.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,900.54 / $3,259.39 / $3,551.16
| Facility | | $2,900.54 | $3,259.39 | $3,551.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,619.43 / $3,156.59 / $3,156.59
| Professional | | $1,619.43 | $3,156.59 | $3,156.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,101.70 / $3,101.70 / $3,101.70
| Facility | | $3,101.70 | $3,101.70 | $3,101.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,639.47 / $3,615.19 / $8,027.76
| Professional | | $2,639.47 | $3,615.19 | $8,027.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,870.99 / $2,961.89 / $4,340.31
| Professional | | $1,870.99 | $2,961.89 | $4,340.31 |