- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $1,930.72 / $3,343.25
| Facility | | $1,277.00 | $1,930.72 | $3,343.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,455.32 / $1,889.24 / $2,239.59
| Professional | | $1,455.32 | $1,889.24 | $2,239.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,509.23 / $1,997.51 / $1,997.51
| Professional | | $1,509.23 | $1,997.51 | $1,997.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,863.14 / $2,644.61 / $3,420.00
| Professional | | $1,863.14 | $2,644.61 | $3,420.00 |
- 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
- $1,466.57 / $2,087.85 / $3,155.52
| Professional | | $1,466.57 | $2,087.85 | $3,155.52 |