- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,556.67 / $13,397.00 / $17,564.40
| Facility | | $2,556.67 | $13,397.00 | $17,564.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,556.67 / $2,556.67 / $2,556.67
| Professional | | $2,556.67 | $2,556.67 | $2,556.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,769.39 / $2,848.32 / $8,927.33
| Facility | | $2,769.39 | $2,848.32 | $8,927.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,488.86 / $3,479.08 / $5,928.04
| Professional | | $1,488.86 | $3,479.08 | $5,928.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,240.00 / $3,726.00 / $13,122.00
| Facility | | $3,240.00 | $3,726.00 | $13,122.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,960.75 / $3,274.03 / $3,883.47
| Professional | | $2,960.75 | $3,274.03 | $3,883.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,193.11 / $1,360.80 / $2,840.75
| Professional | | $1,193.11 | $1,360.80 | $2,840.75 |