- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.81 / $1,339.81 / $1,761.00
| Facility | | $1,339.81 | $1,339.81 | $1,761.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,339.81 / $1,389.03 / $1,603.54
| Professional | | $1,339.81 | $1,389.03 | $1,603.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.00 / $1,342.67 / $1,396.37
| Professional | | $1,007.00 | $1,342.67 | $1,396.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,977.00 / $1,977.00 / $2,471.25
| Professional | | $1,977.00 | $1,977.00 | $2,471.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,761.00 / $1,761.00 / $1,761.00
| Facility | | $1,761.00 | $1,761.00 | $1,761.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,339.81 / $1,389.03 / $1,640.51
| Professional | | $1,339.81 | $1,389.03 | $1,640.51 |