- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,038.00 / $3,904.38 / $4,387.00
| Facility | | $3,038.00 | $3,904.38 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,685.44 / $3,904.38 / $6,430.28
| Professional | | $3,685.44 | $3,904.38 | $6,430.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.74 / $1,916.23 / $2,724.22
| Professional | | $187.74 | $1,916.23 | $2,724.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,798.42 / $5,289.11 / $8,619.93
| Professional | | $3,798.42 | $5,289.11 | $8,619.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,312.00 / $2,446.00 / $13,847.00
| Facility | | $2,312.00 | $2,446.00 | $13,847.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,757.48 / $3,306.41 / $6,016.33
| Professional | | $2,757.48 | $3,306.41 | $6,016.33 |