- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,651.22 / $2,201.62 / $5,283.89
| Facility | | $1,651.22 | $2,201.62 | $5,283.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,629.20 / $1,629.20 / $1,651.22
| Professional | | $1,629.20 | $1,629.20 | $1,651.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,431.05 / $1,431.05 / $1,931.92
| Facility | | $1,431.05 | $1,431.05 | $1,931.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,529.63 / $2,529.63 / $3,162.03
| Professional | | $2,529.63 | $2,529.63 | $3,162.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,475.09 / $1,805.33 / $7,375.43
| Facility | | $1,475.09 | $1,805.33 | $7,375.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.68 / $924.68 / $2,201.62
| Professional | | $924.68 | $924.68 | $2,201.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.68 / $924.68 / $1,320.97
| Professional | | $924.68 | $924.68 | $1,320.97 |