- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,888.44 / $13,182.57
| Facility | | $3,715.35 | $5,888.44 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,090.30 / $3,630.78
| Professional | | $1,905.46 | $3,090.30 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $11,220.18
| Facility | | $3,715.35 | $3,715.35 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $1,513.56 / $3,019.95
| Professional | | $100.00 | $1,513.56 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $6,760.83
| Facility | | $2,454.71 | $3,715.35 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,467.37 / $7,244.36
| Professional | | $1,737.80 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,737.80 / $3,715.35
| Professional | | $1,584.89 | $1,737.80 | $3,715.35 |