- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $1,847.54 / $3,278.73
| Facility | | $1,277.00 | $1,847.54 | $3,278.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.44 / $1,847.54 / $2,295.11
| Professional | | $1,506.44 | $1,847.54 | $2,295.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,484.00 / $1,964.12 / $1,964.12
| Professional | | $1,484.00 | $1,964.12 | $1,964.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,825.00 / $2,516.61 / $3,167.00
| Professional | | $1,825.00 | $2,516.61 | $3,167.00 |
- 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
- $1,393.76 / $1,981.17 / $3,092.92
| Professional | | $1,393.76 | $1,981.17 | $3,092.92 |