- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $1,821.00 / $3,120.35
| Facility | | $1,277.00 | $1,821.00 | $3,120.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,344.51 / $1,761.40 / $2,092.42
| Professional | | $1,344.51 | $1,761.40 | $2,092.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,408.88 / $1,864.69 / $1,864.69
| Professional | | $1,408.88 | $1,864.69 | $1,864.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,731.46 / $2,333.41 / $3,006.44
| Professional | | $1,731.46 | $2,333.41 | $3,006.44 |
- 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
- $1,332.67 / $1,842.17 / $2,936.10
| Professional | | $1,332.67 | $1,842.17 | $2,936.10 |