- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,628.80 / $6,607.00 / $10,492.00
| Facility | | $3,628.80 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,677.54 / $3,628.80 / $5,599.50
| Professional | | $1,677.54 | $3,628.80 | $5,599.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,703.45 / $11,230.09 / $13,227.00
| Facility | | $8,703.45 | $11,230.09 | $13,227.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,130.38 / $4,586.26 / $5,198.27
| Professional | | $2,130.38 | $4,586.26 | $5,198.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,857.49 / $2,308.89 / $6,406.33
| Professional | | $1,857.49 | $2,308.89 | $6,406.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,821.14 / $1,821.14 / $3,696.26
| Professional | | $1,821.14 | $1,821.14 | $3,696.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,275.00 / $5,345.00 / $14,963.00
| Facility | | $3,275.00 | $5,345.00 | $14,963.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,974.78 / $4,201.85 / $8,776.51
| Professional | | $1,974.78 | $4,201.85 | $8,776.51 |