- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.00 / $1,728.00 / $7,278.09
| Facility | | $960.00 | $1,728.00 | $7,278.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,207.10 / $4,216.18 / $7,278.09
| Professional | | $3,207.10 | $4,216.18 | $7,278.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,428.03 / $6,587.17 / $8,861.85
| Facility | | $5,428.03 | $6,587.17 | $8,861.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,035.34 / $4,392.81 / $5,020.35
| Professional | | $3,035.34 | $4,392.81 | $5,020.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,058.03 / $4,256.54 / $13,045.85
| Professional | | $3,058.03 | $4,256.54 | $13,045.85 |
- 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
- $2,472.96 / $3,549.06 / $6,281.84
| Professional | | $2,472.96 | $3,549.06 | $6,281.84 |