- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $2,974.38 / $5,769.25
| Facility | | $1,277.00 | $2,974.38 | $5,769.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,571.54 / $3,279.50 / $3,858.67
| Professional | | $2,571.54 | $3,279.50 | $3,858.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,604.69 / $3,447.39 / $3,447.39
| Professional | | $2,604.69 | $3,447.39 | $3,447.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,230.76 / $4,463.39 / $5,602.88
| Professional | | $3,230.76 | $4,463.39 | $5,602.88 |
- 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
- $2,473.94 / $3,008.42 / $5,449.66
| Professional | | $2,473.94 | $3,008.42 | $5,449.66 |