- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $2,563.51 / $3,911.82
| Facility | | $1,400.00 | $2,563.51 | $3,911.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,099.41 / $2,563.51 / $3,076.86
| Professional | | $2,099.41 | $2,563.51 | $3,076.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,660.44 / $3,029.42 / $3,300.60
| Facility | | $2,660.44 | $3,029.42 | $3,300.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,505.13 / $2,933.87 / $2,933.87
| Professional | | $1,505.13 | $2,933.87 | $2,933.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,847.56 / $2,847.56 / $2,847.56
| Facility | | $2,847.56 | $2,847.56 | $2,847.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,078.16 / $3,331.08 / $6,826.00
| Professional | | $2,078.16 | $3,331.08 | $6,826.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,944.89 / $2,593.26 / $4,038.27
| Professional | | $1,944.89 | $2,593.26 | $4,038.27 |