- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $1,821.00 / $3,109.00
| Facility | | $1,277.00 | $1,821.00 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.43 / $1,671.79 / $2,059.52
| Professional | | $1,300.43 | $1,671.79 | $2,059.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.09 / $1,786.89 / $1,786.89
| Professional | | $1,350.09 | $1,786.89 | $1,786.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,649.02 / $2,421.21 / $3,000.00
| Professional | | $1,649.02 | $2,421.21 | $3,000.00 |
- 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
- $1,301.72 / $1,930.80 / $2,772.43
| Professional | | $1,301.72 | $1,930.80 | $2,772.43 |