- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.77 / $1,152.77 / $9,406.56
| Facility | | $1,152.77 | $1,152.77 | $9,406.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,152.77 / $1,152.77 / $1,198.88
| Professional | | $1,152.77 | $1,152.77 | $1,198.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,229.61 / $1,414.06 / $1,414.06
| Professional | | $1,229.61 | $1,414.06 | $1,414.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,497.65 / $2,597.56 / $5,587.55
| Facility | | $2,497.65 | $2,597.56 | $5,587.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,784.07 / $1,784.07 / $1,960.71
| Professional | | $1,784.07 | $1,784.07 | $1,960.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,767.57 / $3,124.30 / $3,124.30
| Professional | | $1,767.57 | $3,124.30 | $3,124.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.54 / $922.21 / $2,443.86
| Professional | | $645.54 | $922.21 | $2,443.86 |