- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.00 / $1,728.00 / $4,673.07
| Facility | | $960.00 | $1,728.00 | $4,673.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,053.53 / $2,710.32 / $4,673.07
| Professional | | $2,053.53 | $2,710.32 | $4,673.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,496.20 / $10,310.54 / $13,870.99
| Facility | | $8,496.20 | $10,310.54 | $13,870.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,777.55 / $2,678.50 / $3,121.67
| Professional | | $1,777.55 | $2,678.50 | $3,121.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,061.26 / $2,638.07 / $8,047.55
| Professional | | $2,061.26 | $2,638.07 | $8,047.55 |
- 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
- $1,816.56 / $2,431.10 / $3,997.88
| Professional | | $1,816.56 | $2,431.10 | $3,997.88 |