- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.16 / $10,900.00 / $14,552.94
| Facility | | $979.16 | $10,900.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,768.05 / $1,880.70 / $1,880.70
| Professional | | $1,768.05 | $1,880.70 | $1,880.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.08 / $1,200.08 / $1,200.08
| Professional | | $1,200.08 | $1,200.08 | $1,200.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.09 / $1,880.70 / $2,689.40
| Facility | | $412.09 | $1,880.70 | $2,689.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.53 / $2,068.50 / $2,703.55
| Professional | | $796.53 | $2,068.50 | $2,703.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,231.25 / $1,428.25 / $2,250.07
| Professional | | $1,231.25 | $1,428.25 | $2,250.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.09 / $1,880.70 / $2,689.40
| Facility | | $412.09 | $1,880.70 | $2,689.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.49 / $1,527.00 / $2,444.26
| Professional | | $335.49 | $1,527.00 | $2,444.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.06 / $1,440.09 / $5,093.00
| Professional | | $960.06 | $1,440.09 | $5,093.00 |