- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,181.00 / $2,493.00 / $9,477.00
| Facility | | $1,181.00 | $2,493.00 | $9,477.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,407.09 / $3,076.16 / $3,791.64
| Professional | | $2,407.09 | $3,076.16 | $3,791.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,377.08 / $3,146.14 / $3,146.14
| Professional | | $2,377.08 | $3,146.14 | $3,146.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,056.71 / $4,153.00 / $5,298.23
| Professional | | $3,056.71 | $4,153.00 | $5,298.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,056.00 / $2,558.00
| Facility | | $375.00 | $1,056.00 | $2,558.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,371.23 / $3,139.98 / $5,174.28
| Professional | | $2,371.23 | $3,139.98 | $5,174.28 |