- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $5,495.41 / $7,762.47
| Facility | | $1,096.48 | $5,495.41 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,000.00 / $1,778.28
| Professional | | $870.96 | $1,000.00 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,000.00 / $5,128.61
| Professional | | $870.96 | $1,000.00 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,096.48 / $2,884.03
| Professional | | $724.44 | $1,096.48 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $933.25 / $1,819.70
| Professional | | $891.25 | $933.25 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $13,182.57 / $33,884.42
| Facility | | $4,073.80 | $13,182.57 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,000.00 / $2,187.76
| Professional | | $724.44 | $1,000.00 | $2,187.76 |