- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.58 / $1,284.58 / $1,956.46
| Facility | | $1,284.58 | $1,284.58 | $1,956.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.67 / $1,284.58 / $1,540.20
| Professional | | $1,075.67 | $1,284.58 | $1,540.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,329.18 / $1,515.13 / $1,650.77
| Facility | | $1,329.18 | $1,515.13 | $1,650.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.77 / $1,467.35 / $1,467.35
| Professional | | $752.77 | $1,467.35 | $1,467.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,423.86 / $1,423.86 / $1,423.86
| Facility | | $1,423.86 | $1,423.86 | $1,423.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.79 / $1,699.04 / $3,530.32
| Professional | | $1,075.79 | $1,699.04 | $3,530.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.82 / $1,320.61 / $2,004.35
| Professional | | $976.82 | $1,320.61 | $2,004.35 |