- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.00 / $1,728.00 / $4,341.39
| Facility | | $960.00 | $1,728.00 | $4,341.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,437.33 / $4,341.39 / $5,385.12
| Professional | | $2,437.33 | $4,341.39 | $5,385.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,404.27 / $19,907.34 / $26,781.76
| Facility | | $16,404.27 | $19,907.34 | $26,781.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,832.09 / $2,509.71 / $2,961.46
| Professional | | $1,832.09 | $2,509.71 | $2,961.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,252.38 / $3,539.15 / $4,274.92
| Professional | | $2,252.38 | $3,539.15 | $4,274.92 |
- 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
- $1,973.44 / $2,778.09 / $4,196.30
| Professional | | $1,973.44 | $2,778.09 | $4,196.30 |