- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,741.00 / $10,480.00 / $13,413.92
| Facility | | $3,741.00 | $10,480.00 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,751.88 / $3,970.46 / $4,607.74
| Professional | | $3,751.88 | $3,970.46 | $4,607.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,441.73 / $2,441.73 / $2,441.73
| Professional | | $2,441.73 | $2,441.73 | $2,441.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.96 / $3,970.46 / $5,677.76
| Facility | | $894.96 | $3,970.46 | $5,677.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,735.40 / $4,506.60 / $5,853.25
| Professional | | $1,735.40 | $4,506.60 | $5,853.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,682.50 / $3,111.70 / $4,536.39
| Professional | | $2,682.50 | $3,111.70 | $4,536.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.96 / $3,970.46 / $5,677.76
| Facility | | $894.96 | $3,970.46 | $5,677.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.60 / $3,081.00 / $4,584.88
| Professional | | $976.60 | $3,081.00 | $4,584.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,807.75 / $2,946.88 / $6,356.02
| Professional | | $1,807.75 | $2,946.88 | $6,356.02 |