- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $5,805.75 / $9,429.00
| Facility | | $2,100.00 | $5,805.75 | $9,429.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,085.10 / $1,085.11 / $1,193.63
| Professional | | $1,085.10 | $1,085.11 | $1,193.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.79 / $2,362.71 / $4,140.09
| Facility | | $632.79 | $2,362.71 | $4,140.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.90 / $549.60 / $638.91
| Professional | | $480.90 | $549.60 | $638.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,085.11 / $1,193.63 / $6,943.00
| Facility | | $1,085.11 | $1,193.63 | $6,943.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,562.26 / $3,562.26 / $3,562.26
| Professional | | $3,562.26 | $3,562.26 | $3,562.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,350.00 / $6,230.00 / $9,010.00
| Facility | | $2,350.00 | $6,230.00 | $9,010.00 |