- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.00 / $1,728.00 / $8,607.87
| Facility | | $960.00 | $1,728.00 | $8,607.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,783.15 / $5,010.14 / $8,607.87
| Professional | | $3,783.15 | $5,010.14 | $8,607.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,623.49 / $8,037.91 / $10,813.57
| Facility | | $6,623.49 | $8,037.91 | $10,813.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,269.67 / $4,926.89 / $5,742.08
| Professional | | $3,269.67 | $4,926.89 | $5,742.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,656.71 / $4,809.33 / $14,970.17
| Professional | | $3,656.71 | $4,809.33 | $14,970.17 |
- 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
- $3,370.76 / $4,422.22 / $7,191.94
| Professional | | $3,370.76 | $4,422.22 | $7,191.94 |