- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.69 / $3,848.47 / $8,072.00
| Facility | | $2,041.69 | $3,848.47 | $8,072.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,937.58 / $2,245.85 / $3,217.50
| Professional | | $1,937.58 | $2,245.85 | $3,217.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,573.95 / $8,109.09 / $13,917.11
| Facility | | $3,573.95 | $8,109.09 | $13,917.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,571.32 / $2,095.14 / $2,817.08
| Professional | | $1,571.32 | $2,095.14 | $2,817.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $2,354.05
| Facility | | $680.00 | $870.49 | $2,354.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,722.05 / $3,006.98 / $5,377.71
| Professional | | $1,722.05 | $3,006.98 | $5,377.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.00 / $2,575.00 / $7,326.50
| Facility | | $718.00 | $2,575.00 | $7,326.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,860.43 / $2,588.96 / $4,487.91
| Professional | | $1,860.43 | $2,588.96 | $4,487.91 |