- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $1,697.65 / $3,109.00
| Facility | | $1,277.00 | $1,697.65 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,205.50 / $1,697.65 / $1,846.00
| Professional | | $1,205.50 | $1,697.65 | $1,846.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,298.64 / $1,718.78 / $1,718.78
| Professional | | $1,298.64 | $1,718.78 | $1,718.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,485.00 / $2,000.54 / $2,453.62
| Professional | | $1,485.00 | $2,000.54 | $2,453.62 |
- 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
- $1,165.47 / $1,615.04 / $2,635.84
| Professional | | $1,165.47 | $1,615.04 | $2,635.84 |