- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $2,500.00 / $5,320.21
| Facility | | $1,277.00 | $2,500.00 | $5,320.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,895.58 / $3,967.17 / $3,967.17
| Professional | | $2,895.58 | $3,967.17 | $3,967.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,948.71 / $3,902.71 / $3,902.71
| Professional | | $2,948.71 | $3,902.71 | $3,902.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,650.00 / $4,786.26 / $6,328.19
| Professional | | $2,650.00 | $4,786.26 | $6,328.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,056.00 / $2,558.00
| Facility | | $375.00 | $1,056.00 | $2,558.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,288.21 / $3,054.42 / $5,760.81
| Professional | | $2,288.21 | $3,054.42 | $5,760.81 |