- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.86 / $1,770.48 / $4,249.14
| Facility | | $1,327.86 | $1,770.48 | $4,249.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,310.16 / $1,310.16 / $1,894.42
| Professional | | $1,310.16 | $1,310.16 | $1,894.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.81 / $1,150.81 / $1,553.59
| Facility | | $1,150.81 | $1,150.81 | $1,553.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,156.50 / $2,156.50 / $2,583.73
| Professional | | $2,156.50 | $2,156.50 | $2,583.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.16 / $1,669.52 / $2,921.29
| Facility | | $1,310.16 | $1,669.52 | $2,921.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.60 / $743.60 / $2,337.03
| Professional | | $743.60 | $743.60 | $2,337.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.37 / $1,593.43 / $1,770.48
| Facility | | $637.37 | $1,593.43 | $1,770.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.60 / $743.60 / $1,770.48
| Professional | | $743.60 | $743.60 | $1,770.48 |