- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $3,684.00 / $18,600.00
| Facility | | $1,346.00 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,248.94 / $2,288.06 / $2,288.06
| Professional | | $2,248.94 | $2,288.06 | $2,288.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,086.40 / $2,655.83 / $3,111.87
| Professional | | $2,086.40 | $2,655.83 | $3,111.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $2,458.54 / $5,991.35
| Facility | | $773.00 | $2,458.54 | $5,991.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,847.14 / $2,570.19 / $15,123.84
| Professional | | $1,847.14 | $2,570.19 | $15,123.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,760.00 / $6,155.68
| Facility | | $350.00 | $1,760.00 | $6,155.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,719.30 / $2,301.60 / $3,506.08
| Professional | | $1,719.30 | $2,301.60 | $3,506.08 |