- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.80 / $1,397.00 / $4,478.00
| Facility | | $936.80 | $1,397.00 | $4,478.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.87 / $936.80 / $1,114.79
| Professional | | $740.87 | $936.80 | $1,114.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,027.36 / $3,027.36 / $3,632.83
| Facility | | $3,027.36 | $3,027.36 | $3,632.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.04 / $1,113.81 / $1,179.32
| Professional | | $891.04 | $1,113.81 | $1,179.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,849.45 / $2,849.45 / $2,849.45
| Facility | | $2,849.45 | $2,849.45 | $2,849.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.05 / $1,201.75 / $1,526.82
| Professional | | $840.05 | $1,201.75 | $1,526.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.00 / $2,311.00 / $5,626.00
| Facility | | $1,240.00 | $2,311.00 | $5,626.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.40 / $1,019.23 / $1,577.61
| Professional | | $734.40 | $1,019.23 | $1,577.61 |