- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $1,688.00 / $3,109.00
| Facility | | $1,233.00 | $1,688.00 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.33 / $1,459.57 / $1,722.51
| Professional | | $1,087.33 | $1,459.57 | $1,722.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,286.16 / $1,607.70 / $1,702.27
| Professional | | $1,286.16 | $1,607.70 | $1,702.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,315.01 / $1,806.53 / $2,255.15
| Professional | | $1,315.01 | $1,806.53 | $2,255.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.00 / $4,555.00 / $8,929.00
| Facility | | $2,104.00 | $4,555.00 | $8,929.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,107.08 / $1,551.62 / $2,279.34
| Professional | | $1,107.08 | $1,551.62 | $2,279.34 |