- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $2,128.04 / $3,262.93
| Facility | | $1,400.00 | $2,128.04 | $3,262.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,112.16 / $2,223.96 / $3,116.82
| Professional | | $2,112.16 | $2,223.96 | $3,116.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,274.37 / $2,526.90 / $2,753.10
| Facility | | $2,274.37 | $2,526.90 | $2,753.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,255.40 / $2,447.19 / $2,447.19
| Professional | | $1,255.40 | $2,447.19 | $2,447.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,447.00 / $2,447.00 / $2,447.00
| Facility | | $2,447.00 | $2,447.00 | $2,447.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,081.71 / $3,253.49 / $6,572.98
| Professional | | $2,081.71 | $3,253.49 | $6,572.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,738.70 / $2,855.06 / $3,882.38
| Professional | | $1,738.70 | $2,855.06 | $3,882.38 |