- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $2,028.00 / $4,591.60
| Facility | | $1,277.00 | $2,028.00 | $4,591.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,984.74 / $2,550.75 / $2,916.39
| Professional | | $1,984.74 | $2,550.75 | $2,916.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,075.86 / $2,747.46 / $2,747.46
| Professional | | $2,075.86 | $2,747.46 | $2,747.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.00 / $3,264.19 / $3,998.08
| Professional | | $2,100.00 | $3,264.19 | $3,998.08 |
- 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
- $1,556.54 / $2,079.08 / $4,295.00
| Professional | | $1,556.54 | $2,079.08 | $4,295.00 |