- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.00 / $1,728.00 / $2,418.16
| Facility | | $960.00 | $1,728.00 | $2,418.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.58 / $2,418.16 / $2,998.91
| Professional | | $1,274.58 | $2,418.16 | $2,998.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,701.36 / $19,054.33 / $25,634.18
| Facility | | $15,701.36 | $19,054.33 | $25,634.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,247.73 / $3,079.10 / $3,633.34
| Professional | | $2,247.73 | $3,079.10 | $3,633.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,361.70 / $1,971.64 / $4,904.71
| Professional | | $1,361.70 | $1,971.64 | $4,904.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.00 / $1,754.00 / $5,201.00
| Facility | | $650.00 | $1,754.00 | $5,201.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,114.35 / $1,525.25 / $2,408.33
| Professional | | $1,114.35 | $1,525.25 | $2,408.33 |