- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $2,205.05 / $3,343.15
| Facility | | $1,400.00 | $2,205.05 | $3,343.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,840.23 / $2,205.05 / $2,638.19
| Professional | | $1,840.23 | $2,205.05 | $2,638.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,270.59 / $2,589.02 / $2,820.78
| Facility | | $2,270.59 | $2,589.02 | $2,820.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,286.47 / $2,507.36 / $2,507.36
| Professional | | $1,286.47 | $2,507.36 | $2,507.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,436.71 / $2,436.71 / $2,436.71
| Facility | | $2,436.71 | $2,436.71 | $2,436.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,809.36 / $2,924.27 / $6,050.44
| Professional | | $1,809.36 | $2,924.27 | $6,050.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,561.77 / $2,256.63 / $3,367.27
| Professional | | $1,561.77 | $2,256.63 | $3,367.27 |