- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,116.43 / $1,586.65 / $3,109.00
| Facility | | $1,116.43 | $1,586.65 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.74 / $1,199.16 / $1,282.11
| Professional | | $815.74 | $1,199.16 | $1,282.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.78 / $1,184.27 / $1,184.27
| Professional | | $894.78 | $1,184.27 | $1,184.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.00 / $1,391.81 / $1,666.12
| Professional | | $1,075.00 | $1,391.81 | $1,666.12 |
- 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
- $804.10 / $926.75 / $1,707.95
| Professional | | $804.10 | $926.75 | $1,707.95 |