- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $3,600.00 / $13,840.60
| Facility | | $2,367.00 | $3,600.00 | $13,840.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,908.00 / $2,367.00 / $3,600.00
| Professional | | $1,908.00 | $2,367.00 | $3,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,005.10 / $4,220.28 / $8,675.28
| Facility | | $3,005.10 | $4,220.28 | $8,675.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,836.00 / $3,411.37 / $6,894.14
| Professional | | $1,836.00 | $3,411.37 | $6,894.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,379.77 / $11,578.96 / $20,661.97
| Facility | | $5,379.77 | $11,578.96 | $20,661.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,047.12 / $3,417.24 / $7,478.70
| Professional | | $2,047.12 | $3,417.24 | $7,478.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,520.00 / $4,795.20 / $6,840.00
| Professional | | $2,520.00 | $4,795.20 | $6,840.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,512.00 / $2,160.00 / $6,317.64
| Professional | | $1,512.00 | $2,160.00 | $6,317.64 |