- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.06 / $1,383.06 / $1,680.08
| Facility | | $1,383.06 | $1,383.06 | $1,680.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,280.69 / $1,557.88 / $1,969.80
| Professional | | $1,280.69 | $1,557.88 | $1,969.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.91 / $3,307.67 / $4,077.76
| Professional | | $2,951.91 | $3,307.67 | $4,077.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,902.31 / $3,265.42 / $5,029.74
| Professional | | $1,902.31 | $3,265.42 | $5,029.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.06 / $2,190.82 / $2,732.71
| Facility | | $1,383.06 | $2,190.82 | $2,732.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,749.57 / $3,353.26 / $9,617.84
| Professional | | $1,749.57 | $3,353.26 | $9,617.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,719.67 / $3,082.11 / $3,783.27
| Professional | | $1,719.67 | $3,082.11 | $3,783.27 |