- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $2,500.00 / $4,585.08
| Facility | | $1,277.00 | $2,500.00 | $4,585.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,023.57 / $2,594.41 / $3,049.70
| Professional | | $2,023.57 | $2,594.41 | $3,049.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,074.29 / $2,745.38 / $2,745.38
| Professional | | $2,074.29 | $2,745.38 | $2,745.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,560.04 / $3,363.75 / $4,444.66
| Professional | | $2,560.04 | $3,363.75 | $4,444.66 |
- 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
- $1,954.21 / $2,394.27 / $4,339.18
| Professional | | $1,954.21 | $2,394.27 | $4,339.18 |