- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.00 / $1,728.00 / $4,326.04
| Facility | | $960.00 | $1,728.00 | $4,326.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,975.84 / $2,576.58 / $4,326.04
| Professional | | $1,975.84 | $2,576.58 | $4,326.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,083.41 / $7,382.51 / $9,931.84
| Facility | | $6,083.41 | $7,382.51 | $9,931.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.29 / $2,500.30 / $2,912.16
| Professional | | $1,659.29 | $2,500.30 | $2,912.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,936.73 / $2,482.04 / $7,985.91
| Professional | | $1,936.73 | $2,482.04 | $7,985.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.00 / $1,754.00 / $4,083.00
| Facility | | $650.00 | $1,754.00 | $4,083.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,688.45 / $2,251.27 / $3,676.69
| Professional | | $1,688.45 | $2,251.27 | $3,676.69 |