- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $2,028.00 / $4,651.39
| Facility | | $1,277.00 | $2,028.00 | $4,651.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,007.71 / $2,581.55 / $2,955.23
| Professional | | $2,007.71 | $2,581.55 | $2,955.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,103.31 / $2,783.80 / $2,783.80
| Professional | | $2,103.31 | $2,783.80 | $2,783.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.00 / $3,305.07 / $4,049.10
| Professional | | $2,100.00 | $3,305.07 | $4,049.10 |
- 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
- $1,589.41 / $2,087.03 / $4,349.81
| Professional | | $1,589.41 | $2,087.03 | $4,349.81 |